{"hospital_name":"Corporacion del Centro Cardiovascular de Puerto Rico y del Caribe","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Corporacion del Centro Cardiovascular de Puerto Rico y del Caribe"],"hospital_address":["PO Box, 366528, San Juan, PR 00936-6528"],"type_2_npi":["1225017916"],"license_information":{"license_number":"36","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":"Lcdo. Javier A. Marrero Marrero","confirm_attestation":true},"standard_charge_information":[{"description":"Amino acids; single, quantitative, each specimen","code_information":[ { "code": "82131", "type": "APC" } ],"standard_charges":[{"minimum":196.0000,"maximum":196.0000,"gross_charge":196.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":196.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"IgM antibody","code_information":[ { "code": "86705", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"}]}]},{"description":"MR Cardiac magnetic resonance imaging for morphology and funtion without contrast material","code_information":[ { "code": "75557", "type": "APC" } ],"standard_charges":[{"minimum":401.7400,"maximum":401.7400,"gross_charge":401.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"}]}]},{"description":"Partial esophagectomy, distal two-thirds, with thoracotomy only, with or woithout proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty","code_information":[ { "code": "43121", "type": "APC" } ],"standard_charges":[{"minimum":3864.5700,"maximum":3864.5700,"gross_charge":3864.5700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"}]}]},{"description":"Repair of a hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardiopulmonary bypass","code_information":[ { "code": "33852", "type": "APC" } ],"standard_charges":[{"minimum":1897.7700,"maximum":1897.7700,"gross_charge":1897.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"}]}]},{"description":"Transferase Aspartate Amino","code_information":[ { "code": "84450", "type": "APC" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"1 Red Blood Cell Ag Neg\/Unit: 86902","code_information":[ { "code": "86902", "type": "APC" } ],"standard_charges":[{"minimum":97.0000,"maximum":97.0000,"gross_charge":97.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"12 mm & Stapler Bladeless Obturator","code_information":[ { "code": "3021135", "type": "APC" } ],"standard_charges":[{"minimum":1205.4000,"maximum":1205.4000,"gross_charge":1205.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"}]}]},{"description":"12 mm & Stapler Cannula, Long","code_information":[ { "code": "3021136", "type": "APC" } ],"standard_charges":[{"minimum":1911.0000,"maximum":1911.0000,"gross_charge":1911.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"}]}]},{"description":"12-8 mm Reducer","code_information":[ { "code": "3021133", "type": "APC" } ],"standard_charges":[{"minimum":36.8700,"maximum":36.8700,"gross_charge":36.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"}]}]},{"description":"2 Basin Set with Graduated PK","code_information":[ { "code": "270000093", "type": "APC" } ],"standard_charges":[{"minimum":82.2100,"maximum":82.2100,"gross_charge":82.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"}]}]},{"description":"3 Way Stop Cock w\/Swivel Male Luer","code_information":[ { "code": "270000095", "type": "APC" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"}]}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","code_information":[ { "code": "76376", "type": "APC" } ],"standard_charges":[{"minimum":34.3300,"maximum":34.3300,"gross_charge":34.3300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"}]}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","code_information":[ { "code": "76377", "type": "APC" } ],"standard_charges":[{"minimum":108.1900,"maximum":108.1900,"gross_charge":108.1900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"}]}]},{"description":"5071-35 cm Sutureless, unipolar,","code_information":[ { "code": "2711235", "type": "APC" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"}]}]},{"description":"5833SL Disposable Surgical Cable. One","code_information":[ { "code": "270000001", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"7-Band Ligator (Speed Band Superview","code_information":[ { "code": "2810764", "type": "APC" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"}]}]},{"description":"8 Foot Disposable Extension Cable with","code_information":[ { "code": "270000003", "type": "APC" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"}]}]},{"description":"8 mm Bladeless Obturator","code_information":[ { "code": "3021122", "type": "APC" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"}]}]},{"description":"8 mm Bladeless Obturator, Long","code_information":[ { "code": "3021123", "type": "APC" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"}]}]},{"description":"8 mm Instrument Cannula","code_information":[ { "code": "3021124", "type": "APC" } ],"standard_charges":[{"minimum":882.0000,"maximum":882.0000,"gross_charge":882.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"}]}]},{"description":"8 mm Instrument Cannula, Long","code_information":[ { "code": "3021125", "type": "APC" } ],"standard_charges":[{"minimum":956.2000,"maximum":956.2000,"gross_charge":956.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021085", "type": "APC" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021086", "type": "APC" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5880.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021074", "type": "APC" } ],"standard_charges":[{"minimum":10500.0000,"maximum":10500.0000,"gross_charge":10500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021076", "type": "APC" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":10500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021339", "type": "APC" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":10500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor incluiding pleural or chest wall ehen involved by rumor extension, percutaneous, incluiding imaging guidance when performed, unilateral; Cryoablation","code_information":[ { "code": "32994", "type": "APC" } ],"standard_charges":[{"minimum":595.2100,"maximum":595.2100,"gross_charge":595.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"}]}]},{"description":"Accolade MRI DR L311","code_information":[ { "code": "2820784", "type": "APC" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Accolade MRI SR L310","code_information":[ { "code": "3017204", "type": "APC" } ],"standard_charges":[{"minimum":1881.6000,"maximum":1881.6000,"gross_charge":1881.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"}]}]},{"description":"Acetaminophen","code_information":[ { "code": "80143", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Acetylcholine Receptor; binding antibody","code_information":[ { "code": "86041", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Actin, antibody (ASMA), each","code_information":[ { "code": "86015", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Mailman Straigth Tip Veus","code_information":[ { "code": "270000005", "type": "APC" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Amplatz(A6)","code_information":[ { "code": "270000101", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000103", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000105", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000107", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000109", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Multipurpose","code_information":[ { "code": "270000111", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Wide(W)","code_information":[ { "code": "270000113", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Spiral 4592 90CM","code_information":[ { "code": "2820792", "type": "APC" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Universal Cutter (Model 7060)","code_information":[ { "code": "270000115", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View DS CS-J Guide Wire","code_information":[ { "code": "270000117", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View DS Straight Tip","code_information":[ { "code": "270000119", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View EDS CS-J Guide","code_information":[ { "code": "270000007", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View ES Straight Tip","code_information":[ { "code": "270000121", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity X4 Straight 4671 86CM","code_information":[ { "code": "3017469", "type": "APC" } ],"standard_charges":[{"minimum":1478.4000,"maximum":1478.4000,"gross_charge":1478.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"}]}]},{"description":"Acusnare Polypectomy Snare 3 cm x 6 cm","code_information":[ { "code": "270001119", "type": "APC" } ],"standard_charges":[{"minimum":448.0000,"maximum":448.0000,"gross_charge":448.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"}]}]},{"description":"Acute Dual Lumen Catheter Kit 4.5mm x","code_information":[ { "code": "270000123", "type": "APC" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"}]}]},{"description":"Acute Hepatitis Panel","code_information":[ { "code": "80074", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Adapta ADDR03","code_information":[ { "code": "2740034", "type": "APC" } ],"standard_charges":[{"minimum":4543.0000,"maximum":4543.0000,"gross_charge":4543.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"}]}]},{"description":"Adjustable Slitter 6232ADJ","code_information":[ { "code": "270000009", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Adrenalectomy, partial or complete; with excision of adjacent retroperitoneal tumor","code_information":[ { "code": "60545", "type": "APC" } ],"standard_charges":[{"minimum":1719.4200,"maximum":1719.4200,"gross_charge":1719.4200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"}]}]},{"description":"Adrenalectomy, partial or complete; with out radical mediastinal dissection","code_information":[ { "code": "60521", "type": "APC" } ],"standard_charges":[{"minimum":1531.7800,"maximum":1531.7800,"gross_charge":1531.7800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"}]}]},{"description":"Adult Filter","code_information":[ { "code": "2720168", "type": "APC" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"}]}]},{"description":"Adult Hemo Concentrator","code_information":[ { "code": "3020683", "type": "APC" } ],"standard_charges":[{"minimum":145.8400,"maximum":145.8400,"gross_charge":145.8400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"}]}]},{"description":"After Hour Panel - Fee for weekends and holidays","code_information":[ { "code": "99051", "type": "APC" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"}]}]},{"description":"Ag Screening spec order 1-10","code_information":[ { "code": "G0103", "type": "APC" } ],"standard_charges":[{"minimum":59.0000,"maximum":59.0000,"gross_charge":59.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"}]}]},{"description":"Ag Screening spec order 11-20","code_information":[ { "code": "G0102", "type": "APC" } ],"standard_charges":[{"minimum":116.5000,"maximum":116.5000,"gross_charge":116.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"}]}]},{"description":"Ag type per donor Red Blood Cells (RBC) per anligen","code_information":[ { "code": "86904", "type": "APC" } ],"standard_charges":[{"minimum":92.5000,"maximum":92.5000,"gross_charge":92.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"AICD Lead Stylet (Model 6828)","code_information":[ { "code": "270000129", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"AICD Lead Stylets (Model 6972)","code_information":[ { "code": "270000131", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Albumin; , urine, semiquantitative","code_information":[ { "code": "82043", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Albumin; other source, quantitative, each specimen","code_information":[ { "code": "82042", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Albumin; serum, plasma or whole blood","code_information":[ { "code": "82040", "type": "APC" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Albuterol Sulfate Inhalation Aerosol","code_information":[ { "code": "250000075", "type": "APC" } ],"standard_charges":[{"minimum":266.1000,"maximum":266.1000,"gross_charge":266.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"}]}]},{"description":"Alcohol; breath","code_information":[ { "code": "82075", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alcohols","code_information":[ { "code": "80320", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Aldosterone","code_information":[ { "code": "82088", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alexis Wound Protector\/Retractor XS","code_information":[ { "code": "2790934", "type": "APC" } ],"standard_charges":[{"minimum":75.6000,"maximum":75.6000,"gross_charge":75.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"}]}]},{"description":"Alkaloids, not otherwise specified","code_information":[ { "code": "80323", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Allergen Specific IgE; quantitative or semi quantitative, crude allergen extract, each","code_information":[ { "code": "86003", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Allure CRT-P Quadripolar","code_information":[ { "code": "8017738", "type": "APC" } ],"standard_charges":[{"minimum":2612.4000,"maximum":2612.4000,"gross_charge":2612.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"}]}]},{"description":"Alpha 1 Antitrypsin total","code_information":[ { "code": "82103", "type": "APC" } ],"standard_charges":[{"minimum":35.2000,"maximum":35.2000,"gross_charge":35.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alpha Fetoprotein (AFP); serum","code_information":[ { "code": "82105", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Aluminum","code_information":[ { "code": "82108", "type": "APC" } ],"standard_charges":[{"minimum":87.3600,"maximum":87.3600,"gross_charge":87.3600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"}]}]},{"description":"Amikacin Peak","code_information":[ { "code": "80150", "type": "APC" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Amino acids, 6 or more amino acids, quantitative, each specimen","code_information":[ { "code": "82139", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 250MG VIAL","code_information":[ { "code": "J0280", "type": "APC" } ],"standard_charges":[{"minimum":18.5800,"maximum":18.5800,"gross_charge":18.5800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"}]}]},{"description":"Ammonia","code_information":[ { "code": "82140", "type": "APC" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Amphetamine","code_information":[ { "code": "80324", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Piccolo Occluder Duct","code_information":[ { "code": "3019766", "type": "APC" } ],"standard_charges":[{"minimum":11900.0000,"maximum":11900.0000,"gross_charge":11900.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3010991", "type": "APC" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3011012", "type": "APC" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Duct Occluder 12mm\/10mm\/8mm","code_information":[ { "code": "2780732", "type": "APC" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Guidewire 260cm\/1.5mm Abbott","code_information":[ { "code": "2780726", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Multifenestrated Septal","code_information":[ { "code": "2780736", "type": "APC" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Muscular VSD Occluder","code_information":[ { "code": "2780735", "type": "APC" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer PFO Occluder 18mm Abbott","code_information":[ { "code": "3017640", "type": "APC" } ],"standard_charges":[{"minimum":7560.0000,"maximum":7560.0000,"gross_charge":7560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Septal Occluder 10mm Abbott","code_information":[ { "code": "2780729", "type": "APC" } ],"standard_charges":[{"minimum":6650.0000,"maximum":6650.0000,"gross_charge":6650.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 18mm\/70cm","code_information":[ { "code": "270000135", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 24mm\/70cm","code_information":[ { "code": "270000137", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 34mm\/70cm","code_information":[ { "code": "270000139", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman 45 Delivery System","code_information":[ { "code": "270000141", "type": "APC" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman Delivery Sheath 9F","code_information":[ { "code": "270000143", "type": "APC" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman PFO Occluder","code_information":[ { "code": "3020851", "type": "APC" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000145", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000147", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45 Delivery System","code_information":[ { "code": "270000149", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45x45 14F\/80cm","code_information":[ { "code": "270000151", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45x45 Delivery","code_information":[ { "code": "270000153", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000155", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000157", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000159", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000161", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000163", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000165", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000167", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000169", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000171", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amputation Foot; midtarsal","code_information":[ { "code": "28800", "type": "APC" } ],"standard_charges":[{"minimum":729.1100,"maximum":729.1100,"gross_charge":729.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"}]}]},{"description":"Amputation metatarsal with toe single","code_information":[ { "code": "28810", "type": "APC" } ],"standard_charges":[{"minimum":584.8500,"maximum":584.8500,"gross_charge":584.8500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"}]}]},{"description":"Amputation, forearm, through radius and ulna","code_information":[ { "code": "25900", "type": "APC" } ],"standard_charges":[{"minimum":1002.4700,"maximum":1002.4700,"gross_charge":1002.4700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"}]}]},{"description":"Amputation, leg, through tibia and fibula","code_information":[ { "code": "27880", "type": "APC" } ],"standard_charges":[{"minimum":1229.8900,"maximum":1229.8900,"gross_charge":1229.8900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"}]}]},{"description":"Amputation, thigh, through femur, any level","code_information":[ { "code": "27590", "type": "APC" } ],"standard_charges":[{"minimum":1073.9800,"maximum":1073.9800,"gross_charge":1073.9800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"}]}]},{"description":"Amylase","code_information":[ { "code": "82150", "type": "APC" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Androstenedione","code_information":[ { "code": "82157", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 4F\/100cm\/.38\"","code_information":[ { "code": "270000177", "type": "APC" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 4F\/65cm\/.035\"","code_information":[ { "code": "270000179", "type": "APC" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 5F\/100cm\/.38\"","code_information":[ { "code": "270000181", "type": "APC" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 5F\/65cm\/PIGTAIL","code_information":[ { "code": "270000183", "type": "APC" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter Extension 100cm","code_information":[ { "code": "270000185", "type": "APC" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter Extension 65cm","code_information":[ { "code": "270000187", "type": "APC" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter UF 5F\/65cm\/.035\"","code_information":[ { "code": "270000189", "type": "APC" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheters","code_information":[ { "code": "270000191", "type": "APC" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"}]}]},{"description":"Angiography Adrenal bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75733", "type": "APC" } ],"standard_charges":[{"minimum":238.1500,"maximum":238.1500,"gross_charge":238.1500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"}]}]},{"description":"Angiography Adrenal unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75731", "type": "APC" } ],"standard_charges":[{"minimum":211.8800,"maximum":211.8800,"gross_charge":211.8800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"}]}]},{"description":"Angiography Extremity Bilateral radiological supervision and interpretation","code_information":[ { "code": "75716", "type": "APC" } ],"standard_charges":[{"minimum":224.3800,"maximum":224.3800,"gross_charge":224.3800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"}]}]},{"description":"Angiography Extremity. Unilateral radiological supervision and interpretation","code_information":[ { "code": "75710", "type": "APC" } ],"standard_charges":[{"minimum":206.8800,"maximum":206.8800,"gross_charge":206.8800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"}]}]},{"description":"Angiography pelvic, selective or supraselective, radiological supervision and interpretation","code_information":[ { "code": "75736", "type": "APC" } ],"standard_charges":[{"minimum":198.0000,"maximum":198.0000,"gross_charge":198.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"}]}]},{"description":"Angiography spinal selective radiological supervision and interpretation","code_information":[ { "code": "75705", "type": "APC" } ],"standard_charges":[{"minimum":345.4500,"maximum":345.4500,"gross_charge":345.4500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"}]}]},{"description":"Angiography visceral, selective or suoraselective, radiological supervision and interpretation","code_information":[ { "code": "75726", "type": "APC" } ],"standard_charges":[{"minimum":234.1200,"maximum":234.1200,"gross_charge":234.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75743", "type": "APC" } ],"standard_charges":[{"minimum":203.3500,"maximum":203.3500,"gross_charge":203.3500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, by nonselective catheter or venous injection radiological supervision and interpretation","code_information":[ { "code": "75746", "type": "APC" } ],"standard_charges":[{"minimum":186.0300,"maximum":186.0300,"gross_charge":186.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75741", "type": "APC" } ],"standard_charges":[{"minimum":179.0300,"maximum":179.0300,"gross_charge":179.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"}]}]},{"description":"Angio-Seal Vascular Closure Device 6F","code_information":[ { "code": "2780198", "type": "APC" } ],"standard_charges":[{"minimum":245.0000,"maximum":245.0000,"gross_charge":245.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"}]}]},{"description":"Angiotensin I - converting enzyme (ACE)","code_information":[ { "code": "82164", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"}]}]},{"description":"Angio-Touch Kit AT X65","code_information":[ { "code": "270000193", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Anti Phospholipid Antibody","code_information":[ { "code": "86148", "type": "APC" } ],"standard_charges":[{"minimum":331.8000,"maximum":331.8000,"gross_charge":331.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"}]}]},{"description":"Antibody elution (RBC) each","code_information":[ { "code": "86860", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody identification, RBC antibodies, each panel for each serum technique","code_information":[ { "code": "86870", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody screen, RBC, each serum technique","code_information":[ { "code": "86850", "type": "APC" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody; Influenza Virus","code_information":[ { "code": "86710", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antidepressants, tricyclic and other cyclicals; 6 or more","code_information":[ { "code": "80337", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test (Coombs test); direct, each antiserum","code_information":[ { "code": "86880", "type": "APC" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test; Indirect, each antibody titer","code_information":[ { "code": "86886", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test; Indirect, qualitative, each reagent","code_information":[ { "code": "86885", "type": "APC" } ],"standard_charges":[{"minimum":17.5000,"maximum":17.5000,"gross_charge":17.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNeutrophil Cytoplasmic Antibody; screen each antibody","code_information":[ { "code": "86036", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNuclear Antibodies Titer","code_information":[ { "code": "86039", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNuclear Antibodies;","code_information":[ { "code": "86038", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin O Screen","code_information":[ { "code": "86063", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin O Titer","code_information":[ { "code": "86060", "type": "APC" } ],"standard_charges":[{"minimum":10.0100,"maximum":10.0100,"gross_charge":10.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"}]}]},{"description":"Aorta Punch 4.0","code_information":[ { "code": "270001123", "type": "APC" } ],"standard_charges":[{"minimum":52.2800,"maximum":52.2800,"gross_charge":52.2800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"}]}]},{"description":"Aortic Balloon 10Fr x 120 cm x 0.038\"","code_information":[ { "code": "2704965", "type": "APC" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Canula Adult","code_information":[ { "code": "2702320", "type": "APC" } ],"standard_charges":[{"minimum":51.1000,"maximum":51.1000,"gross_charge":51.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"}]}]},{"description":"Aortic FlexCuff Rotatable Mechanical","code_information":[ { "code": "2703875", "type": "APC" } ],"standard_charges":[{"minimum":5726.0000,"maximum":5726.0000,"gross_charge":5726.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Regent Flex W\/O Silicone Model:","code_information":[ { "code": "2790177", "type": "APC" } ],"standard_charges":[{"minimum":5425.0000,"maximum":5425.0000,"gross_charge":5425.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"}]}]},{"description":"Aorto Punch 4.5","code_information":[ { "code": "270001125", "type": "APC" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"}]}]},{"description":"Aorto Punch 4.8","code_information":[ { "code": "2700051", "type": "APC" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"Aortography Abdominal by Serialography radiological supervision and interpretation","code_information":[ { "code": "75625", "type": "APC" } ],"standard_charges":[{"minimum":177.1300,"maximum":177.1300,"gross_charge":177.1300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"}]}]},{"description":"Aortography abdominal plus bilateral iliofemoral lower extremity, catheter by seriolography, radiological supervision and interpretation","code_information":[ { "code": "75630", "type": "APC" } ],"standard_charges":[{"minimum":219.6500,"maximum":219.6500,"gross_charge":219.6500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"}]}]},{"description":"Aortography Thoracic by Serialography radiological supervision and interpretation","code_information":[ { "code": "75605", "type": "APC" } ],"standard_charges":[{"minimum":166.6000,"maximum":166.6000,"gross_charge":166.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"}]}]},{"description":"Aortography Thoracic Without Serialography radiological supervision and interpretation","code_information":[ { "code": "75600", "type": "APC" } ],"standard_charges":[{"minimum":252.2500,"maximum":252.2500,"gross_charge":252.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"}]}]},{"description":"Apheresis Imported from US","code_information":[ { "code": "EU102", "type": "APC" } ],"standard_charges":[{"minimum":750.0000,"maximum":750.0000,"gross_charge":750.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"}]}]},{"description":"Apolipoprotein, each","code_information":[ { "code": "82172", "type": "APC" } ],"standard_charges":[{"minimum":29.1200,"maximum":29.1200,"gross_charge":29.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Appendectomy","code_information":[ { "code": "44950", "type": "APC" } ],"standard_charges":[{"minimum":885.4700,"maximum":885.4700,"gross_charge":885.4700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"}]}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20690", "type": "APC" } ],"standard_charges":[{"minimum":827.9900,"maximum":827.9900,"gross_charge":827.9900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"}]}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20692", "type": "APC" } ],"standard_charges":[{"minimum":1591.1400,"maximum":1591.1400,"gross_charge":827.9900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"}]}]},{"description":"Appose ULC Slim Body Skin Stapler 35","code_information":[ { "code": "3021163", "type": "APC" } ],"standard_charges":[{"minimum":504.0000,"maximum":504.0000,"gross_charge":504.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"}]}]},{"description":"Argyle Latex Penrose Tubbing 38 mm x","code_information":[ { "code": "270001127", "type": "APC" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cereb, Unill","code_information":[ { "code": "75665", "type": "APC" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cerebral, Bil","code_information":[ { "code": "75671", "type": "APC" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cerv, Unil","code_information":[ { "code": "75676", "type": "APC" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cervical, Bil","code_information":[ { "code": "75680", "type": "APC" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition","code_information":[ { "code": "36818", "type": "APC" } ],"standard_charges":[{"minimum":927.7800,"maximum":927.7800,"gross_charge":927.7800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)","code_information":[ { "code": "36821", "type": "APC" } ],"standard_charges":[{"minimum":887.9200,"maximum":887.9200,"gross_charge":887.9200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"}]}]},{"description":"Arterio-Vertebral, Angio UNI","code_information":[ { "code": "75685", "type": "APC" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints) surgical; with removal of loose body or foreing body","code_information":[ { "code": "29894", "type": "APC" } ],"standard_charges":[{"minimum":702.5600,"maximum":702.5600,"gross_charge":702.5600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, hip, diagnostic with or without synovial biopsy","code_information":[ { "code": "29860", "type": "APC" } ],"standard_charges":[{"minimum":914.6600,"maximum":914.6600,"gross_charge":914.6600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, diagnostic with or without synovial biopsy","code_information":[ { "code": "29870", "type": "APC" } ],"standard_charges":[{"minimum":576.0300,"maximum":576.0300,"gross_charge":576.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, shoulder, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29805", "type": "APC" } ],"standard_charges":[{"minimum":654.9900,"maximum":654.9900,"gross_charge":654.9900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29840", "type": "APC" } ],"standard_charges":[{"minimum":632.6300,"maximum":632.6300,"gross_charge":632.6300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)","code_information":[ { "code": "33859", "type": "APC" } ],"standard_charges":[{"minimum":3273.3100,"maximum":3273.3100,"gross_charge":3273.3100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic dissection","code_information":[ { "code": "33858", "type": "APC" } ],"standard_charges":[{"minimum":4553.1100,"maximum":4553.1100,"gross_charge":4553.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"}]}]},{"description":"ASPA gene analysis, common variants","code_information":[ { "code": "81200", "type": "APC" } ],"standard_charges":[{"minimum":582.4000,"maximum":582.4000,"gross_charge":582.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"}]}]},{"description":"Aspergillus","code_information":[ { "code": "86606", "type": "APC" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"}]}]},{"description":"Assurity MRI DR Pulse Generator PM2272","code_information":[ { "code": "2820766", "type": "APC" } ],"standard_charges":[{"minimum":3129.0000,"maximum":3129.0000,"gross_charge":3129.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"}]}]},{"description":"Atrial septectomy or septostomy; open heart cardiopulmonary bypass","code_information":[ { "code": "33736", "type": "APC" } ],"standard_charges":[{"minimum":1909.8400,"maximum":1909.8400,"gross_charge":1909.8400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"}]}]},{"description":"AtriCure cryoICE\/Cryoablation Probe 10","code_information":[ { "code": "3020712", "type": "APC" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure cryoICE\/cryoSPHERE 18''","code_information":[ { "code": "270000201", "type": "APC" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"}]}]},{"description":"AtriCure Isolator SYNERGY","code_information":[ { "code": "3020711", "type": "APC" } ],"standard_charges":[{"minimum":2205.0000,"maximum":2205.0000,"gross_charge":2205.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V #45","code_information":[ { "code": "3021066", "type": "APC" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 50","code_information":[ { "code": "3021067", "type": "APC" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 35","code_information":[ { "code": "3020713", "type": "APC" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 40","code_information":[ { "code": "3021065", "type": "APC" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"Atrion QL 2530 Disposable Inflation","code_information":[ { "code": "270000205", "type": "APC" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Atrion QL38 Locking Syringe Device","code_information":[ { "code": "270000207", "type": "APC" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Ability MRI SureScan 4196-78","code_information":[ { "code": "2720393", "type": "APC" } ],"standard_charges":[{"minimum":756.0000,"maximum":756.0000,"gross_charge":756.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MB2","code_information":[ { "code": "270000011", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MP","code_information":[ { "code": "270000013", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MPR","code_information":[ { "code": "270000015", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command+ SureValve 6250V-EH","code_information":[ { "code": "270000017", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"ATTAIN HYBRID Guide Wire GWR419688","code_information":[ { "code": "270000019", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa MRI SureScan 4298- 88","code_information":[ { "code": "2701548", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa MRI SureScan 4298-78","code_information":[ { "code": "2820686", "type": "APC" } ],"standard_charges":[{"minimum":1960.0000,"maximum":1960.0000,"gross_charge":1960.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa Straight MRI SureScan","code_information":[ { "code": "2720944", "type": "APC" } ],"standard_charges":[{"minimum":700.0000,"maximum":700.0000,"gross_charge":700.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Select II + Sure Valve","code_information":[ { "code": "270000021", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Select II + SureValve","code_information":[ { "code": "270000023", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Stability Quad MRI SureScan","code_information":[ { "code": "3021029", "type": "APC" } ],"standard_charges":[{"minimum":973.0000,"maximum":973.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"}]}]},{"description":"Attesta DR MRI SureScan ATDR01","code_information":[ { "code": "3020146", "type": "APC" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"Auto Suture Circular Stapler with DST","code_information":[ { "code": "2760737", "type": "APC" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"}]}]},{"description":"Auto Transfusion Complete Kit (Wash","code_information":[ { "code": "3021054", "type": "APC" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"}]}]},{"description":"Autologous blood or component, collection processing and storage; predeposited","code_information":[ { "code": "86890", "type": "APC" } ],"standard_charges":[{"minimum":250.0000,"maximum":250.0000,"gross_charge":250.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 10F\/11cm","code_information":[ { "code": "270000209", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 5F\/11cm","code_information":[ { "code": "270000213", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 6Fr\/11cm","code_information":[ { "code": "270000215", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 7F\/11cm","code_information":[ { "code": "270000217", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021249", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 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separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021251", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001361", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001363", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001365", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001371", "type": "APC" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001359", "type": "APC" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001367", "type": "APC" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001369", "type": "APC" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR Detachment Controller","code_information":[ { "code": "3021248", "type": "APC" } ],"standard_charges":[{"minimum":186.0000,"maximum":186.0000,"gross_charge":186.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"}]}]},{"description":"Azure XT DR MRI SureScan W1DR01","code_information":[ { "code": "3019421", "type": "APC" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"Azure XT SR MRI SureScan W1SR01","code_information":[ { "code": "3019301", "type": "APC" } ],"standard_charges":[{"minimum":2310.0000,"maximum":2310.0000,"gross_charge":2310.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"}]}]},{"description":"Babesia microti, amplified probe technique","code_information":[ { "code": "87469", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Baby Rx Oxygenators Neonatal","code_information":[ { "code": "2780945", "type": "APC" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"}]}]},{"description":"Bacterial Detection PCR - Infectious Agent Antigen Detection; amplified probe technique","code_information":[ { "code": "87801", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bair Hugger","code_information":[ { "code": "2700097", "type": "APC" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Balloon Catheter Model 6714 6F 90cm","code_information":[ { "code": "270000219", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Band 638bl #26 CG Future Anulo 29L","code_information":[ { "code": "2800636", "type": "APC" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"Banding Pulmonary Artery","code_information":[ { "code": "33690", "type": "APC" } ],"standard_charges":[{"minimum":1660.9700,"maximum":1660.9700,"gross_charge":1660.9700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"}]}]},{"description":"Barbiturates","code_information":[ { "code": "80345", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Basic Metabolic Panel","code_information":[ { "code": "80048", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Benzodiazepines; 1 - 12","code_information":[ { "code": "80346", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"b-Hexosaminidase, each assay","code_information":[ { "code": "83080", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"BI-Cava Fem Cannula 24\/29","code_information":[ { "code": "2760250", "type": "APC" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; direct","code_information":[ { "code": "82248", "type": "APC" } ],"standard_charges":[{"minimum":5.0000,"maximum":5.0000,"gross_charge":5.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; total","code_information":[ { "code": "82247", "type": "APC" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bio pump Perfusion Service (Biomedics","code_information":[ { "code": "2740010", "type": "APC" } ],"standard_charges":[{"minimum":299.0000,"maximum":299.0000,"gross_charge":299.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"}]}]},{"description":"BioGlue Syringe Surgical Adhesive 5 ml","code_information":[ { "code": "270001129", "type": "APC" } ],"standard_charges":[{"minimum":653.8000,"maximum":653.8000,"gross_charge":653.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"}]}]},{"description":"Bio-Medicus Percutaneus Kit 25F","code_information":[ { "code": "270000265", "type": "APC" } ],"standard_charges":[{"minimum":1008.0000,"maximum":1008.0000,"gross_charge":1008.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"}]}]},{"description":"Biopsy of the liver, needle; percutaneous","code_information":[ { "code": "47000", "type": "APC" } ],"standard_charges":[{"minimum":118.3700,"maximum":118.3700,"gross_charge":118.3700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"}]}]},{"description":"Biopsy Valve MAJ 210","code_information":[ { "code": "3008851", "type": "APC" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"}]}]},{"description":"Bipolar Pacing 5 Fr","code_information":[ { "code": "2710634", "type": "APC" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Bipolar Temporary Pacing","code_information":[ { "code": "2770176", "type": "APC" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Bladeless Trocars with Stability","code_information":[ { "code": "270000277", "type": "APC" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Blake Drain # 15","code_information":[ { "code": "270001131", "type": "APC" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blake Drain # 19","code_information":[ { "code": "270001133", "type": "APC" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blake Drains # 10","code_information":[ { "code": "270001135", "type": "APC" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blastomyces","code_information":[ { "code": "86612", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bleeding Time","code_information":[ { "code": "85002", "type": "APC" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Blod count; hematocrit","code_information":[ { "code": "85014", "type": "APC" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"}]}]},{"description":"Blod count; Hemoglobin","code_information":[ { "code": "85018", "type": "APC" } ],"standard_charges":[{"minimum":18.2000,"maximum":18.2000,"gross_charge":18.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"}]}]},{"description":"Blood (whole) for transfusion, per unit","code_information":[ { "code": "P9010", "type": "APC" } ],"standard_charges":[{"minimum":180.0000,"maximum":180.0000,"gross_charge":180.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; Autorization for deviation from standard blood banking procedures (ex, use of outdated blood, transfusion of RH incompatible untis) with written report","code_information":[ { "code": "86079", "type": "APC" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; difficult cross match and\/or evaluation of irregular antibody(s), interpretationand written report","code_information":[ { "code": "86077", "type": "APC" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; investigation of transfusion reaction including suspicion of transissible disease, interpretation and written report","code_information":[ { "code": "86078", "type": "APC" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)","code_information":[ { "code": "85027", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differencial WBC count","code_information":[ { "code": "85025", "type": "APC" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; Platelet, automated","code_information":[ { "code": "85049", "type": "APC" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; Reticulocyte Manual","code_information":[ { "code": "85044", "type": "APC" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocyte, automated, including 1 or more cellular parameters, immature reticulocyte fraction, reticulocyte volumen, direct measurement","code_information":[ { "code": "85046", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood smear, pheripheral, interpretation by physician with written report","code_information":[ { "code": "85060", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood split unit","code_information":[ { "code": "P9011", "type": "APC" } ],"standard_charges":[{"minimum":225.0000,"maximum":225.0000,"gross_charge":225.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; ABO","code_information":[ { "code": "86900", "type": "APC" } ],"standard_charges":[{"minimum":31.5000,"maximum":31.5000,"gross_charge":31.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Blood typing; RH D","code_information":[ { "code": "86901", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","code_information":[ { "code": "82274", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening","code_information":[ { "code": "82270", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, other sources","code_information":[ { "code": "82271", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bordetella","code_information":[ { "code": "86615", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi","code_information":[ { "code": "86618", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi confirmatory test","code_information":[ { "code": "86617", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi, amplified probe technique","code_information":[ { "code": "87476", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia miyamotoi, amplified probe technique","code_information":[ { "code": "87478", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bowl (SP Multipurpose Container)","code_information":[ { "code": "2705406", "type": "APC" } ],"standard_charges":[{"minimum":35.1400,"maximum":35.1400,"gross_charge":35.1400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"}]}]},{"description":"Bronchoscope Cytology Brush G22178","code_information":[ { "code": "270001139", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with destruction of tumor or relief of stenosis by any method other than excision","code_information":[ { "code": "31641", "type": "APC" } ],"standard_charges":[{"minimum":341.2400,"maximum":341.2400,"gross_charge":341.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with Endobronchial ultrasound guide transtracheal and\/or transbrochial sampling aspiration 3 or more mediastinal and\/or hilar lymph node stations or structures","code_information":[ { "code": "31653", "type": "APC" } ],"standard_charges":[{"minimum":333.3700,"maximum":333.3700,"gross_charge":333.3700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with excisting tumor","code_information":[ { "code": "31640", "type": "APC" } ],"standard_charges":[{"minimum":332.0700,"maximum":332.0700,"gross_charge":332.0700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay","code_information":[ { "code": "31646", "type": "APC" } ],"standard_charges":[{"minimum":194.4700,"maximum":194.4700,"gross_charge":194.4700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with therapeutic aspiration of tracheobronchial tree; initial","code_information":[ { "code": "31645", "type": "APC" } ],"standard_charges":[{"minimum":198.1700,"maximum":198.1700,"gross_charge":198.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with tracheal\/bronchial dilatation or closed reduction of fracture","code_information":[ { "code": "31630", "type": "APC" } ],"standard_charges":[{"minimum":266.9200,"maximum":266.9200,"gross_charge":266.9200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy(s) single lobe","code_information":[ { "code": "31628", "type": "APC" } ],"standard_charges":[{"minimum":236.2500,"maximum":236.2500,"gross_charge":236.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, trachea, main stem and\/or lobar bronchus","code_information":[ { "code": "31629", "type": "APC" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with placement of tracheal stent(s) (includes tracheal\/bronchial dilation as required)","code_information":[ { "code": "31631", "type": "APC" } ],"standard_charges":[{"minimum":304.0700,"maximum":304.0700,"gross_charge":304.0700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with removal of foreing body","code_information":[ { "code": "31635", "type": "APC" } ],"standard_charges":[{"minimum":236.2100,"maximum":236.2100,"gross_charge":236.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy each additional lobe","code_information":[ { "code": "31632", "type": "APC" } ],"standard_charges":[{"minimum":65.5800,"maximum":65.5800,"gross_charge":65.5800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, each additional lobe","code_information":[ { "code": "31633", "type": "APC" } ],"standard_charges":[{"minimum":85.7600,"maximum":85.7600,"gross_charge":85.7600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; diagnostic, with cell washing, when performed","code_information":[ { "code": "31622", "type": "APC" } ],"standard_charges":[{"minimum":178.8600,"maximum":178.8600,"gross_charge":178.8600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial alveolar lavage","code_information":[ { "code": "31624", "type": "APC" } ],"standard_charges":[{"minimum":179.8400,"maximum":179.8400,"gross_charge":179.8400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial or endobronchial biopsy single or multiple sites","code_information":[ { "code": "31625", "type": "APC" } ],"standard_charges":[{"minimum":210.0800,"maximum":210.0800,"gross_charge":210.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with brushing or protected brushing","code_information":[ { "code": "31623", "type": "APC" } ],"standard_charges":[{"minimum":177.5500,"maximum":177.5500,"gross_charge":177.5500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with computer-assisted, image-guided navigation","code_information":[ { "code": "31627", "type": "APC" } ],"standard_charges":[{"minimum":129.2900,"maximum":129.2900,"gross_charge":129.2900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"}]}]},{"description":"Brucella","code_information":[ { "code": "86622", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Buprenorphine","code_information":[ { "code": "80348", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortobifemoral","code_information":[ { "code": "35646", "type": "APC" } ],"standard_charges":[{"minimum":2282.6600,"maximum":2282.6600,"gross_charge":2282.6600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal","code_information":[ { "code": "35631", "type": "APC" } ],"standard_charges":[{"minimum":2481.2100,"maximum":2481.2100,"gross_charge":2481.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortofemoral","code_information":[ { "code": "35647", "type": "APC" } ],"standard_charges":[{"minimum":2076.4000,"maximum":2076.4000,"gross_charge":2076.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortoiliac","code_information":[ { "code": "35637", "type": "APC" } ],"standard_charges":[{"minimum":2221.1700,"maximum":2221.1700,"gross_charge":2221.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or personal artery","code_information":[ { "code": "35666", "type": "APC" } ],"standard_charges":[{"minimum":1755.1100,"maximum":1755.1100,"gross_charge":1755.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-femoral","code_information":[ { "code": "35661", "type": "APC" } ],"standard_charges":[{"minimum":1475.6000,"maximum":1475.6000,"gross_charge":1475.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-polpliteal","code_information":[ { "code": "35656", "type": "APC" } ],"standard_charges":[{"minimum":1437.1100,"maximum":1437.1100,"gross_charge":1437.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"}]}]},{"description":"C A 19 21","code_information":[ { "code": "86301", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"C Reactive Protein","code_information":[ { "code": "86140", "type": "APC" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"C V Pediatric Pack (Bundle)","code_information":[ { "code": "270001141", "type": "APC" } ],"standard_charges":[{"minimum":173.2500,"maximum":173.2500,"gross_charge":173.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"}]}]},{"description":"Calcitonin","code_information":[ { "code": "82308", "type": "APC" } ],"standard_charges":[{"minimum":154.0000,"maximum":154.0000,"gross_charge":154.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"}]}]},{"description":"Calcium Alginate Dressing 4 X 4","code_information":[ { "code": "2709142", "type": "APC" } ],"standard_charges":[{"minimum":65.4900,"maximum":65.4900,"gross_charge":65.4900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"}]}]},{"description":"Calcium; ionized","code_information":[ { "code": "82330", "type": "APC" } ],"standard_charges":[{"minimum":82.9500,"maximum":82.9500,"gross_charge":82.9500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"}]}]},{"description":"Calcium; total","code_information":[ { "code": "82310", "type": "APC" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Calcium; urine quantitative, timed specimen","code_information":[ { "code": "82340", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Candida species, direct probe technique","code_information":[ { "code": "87480", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cannabinoids, natural","code_information":[ { "code": "80349", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Capsure EPI 4968-35 cm","code_information":[ { "code": "2700317", "type": "APC" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Fix vus MRI Sure Scan","code_information":[ { "code": "2700329", "type": "APC" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Fix vus MRI SureScan","code_information":[ { "code": "2711312", "type": "APC" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Sense MRI SureScan 4074-58 cm","code_information":[ { "code": "2700313", "type": "APC" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Sense MRI SureScan 4574-53 cm","code_information":[ { "code": "2700326", "type": "APC" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"Captura Biopsy Forceps W Spike 160 cm","code_information":[ { "code": "2700455", "type": "APC" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"}]}]},{"description":"Captura Biopsy Forceps With Spike 230","code_information":[ { "code": "270001143", "type": "APC" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine; free","code_information":[ { "code": "80157", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine; total","code_information":[ { "code": "80156", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"}]}]},{"description":"Carbon dioxide (Bicarbonate)","code_information":[ { "code": "82374", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Carcinoembryonic Antigen (CEA)","code_information":[ { "code": "82378", "type": "APC" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiolipin Antibody Ig","code_information":[ { "code": "86147", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioplegia Cannula 16 Ga","code_information":[ { "code": "2703860", "type": "APC" } ],"standard_charges":[{"minimum":230.0000,"maximum":230.0000,"gross_charge":230.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioplegia Pack Perfusion","code_information":[ { "code": "2740005", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiopulmonary Bypass Perfusion","code_information":[ { "code": "360001727", "type": "APC" } ],"standard_charges":[{"minimum":3107.9300,"maximum":3107.9300,"gross_charge":3107.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"}]}]},{"description":"Cardiore Forceps","code_information":[ { "code": "3021116", "type": "APC" } ],"standard_charges":[{"minimum":3969.0000,"maximum":3969.0000,"gross_charge":3969.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioroot Woven Collagen Coated","code_information":[ { "code": "2890204", "type": "APC" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiotomy Reservoir","code_information":[ { "code": "2703070", "type": "APC" } ],"standard_charges":[{"minimum":150.0000,"maximum":150.0000,"gross_charge":150.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; tracing only, without interpretation and report","code_information":[ { "code": "93017", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"}]}]},{"description":"Cardioversion elective, electrical of arrhythmia; external","code_information":[ { "code": "92960", "type": "APC" } ],"standard_charges":[{"minimum":145.9800,"maximum":145.9800,"gross_charge":145.9800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"}]}]},{"description":"Carnitine (total and free), quantitative, each specimen","code_information":[ { "code": "82379", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Carotid Artery Loop Shunt","code_information":[ { "code": "270001145", "type": "APC" } ],"standard_charges":[{"minimum":34.3000,"maximum":34.3000,"gross_charge":34.3000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"}]}]},{"description":"Catecholamine; fractionated","code_information":[ { "code": "82384", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Catheter 227F3 Freezor XTRA3 MED7F","code_information":[ { "code": "3019976", "type": "APC" } ],"standard_charges":[{"minimum":1470.0000,"maximum":1470.0000,"gross_charge":1470.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","code_information":[ { "code": "93458", "type": "APC" } ],"standard_charges":[{"minimum":1416.8800,"maximum":1416.8800,"gross_charge":1416.8800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with rigth and left heart catherrization including intraprocedural injections for left ventricullography, when performd","code_information":[ { "code": "93460", "type": "APC" } ],"standard_charges":[{"minimum":1690.7500,"maximum":1690.7500,"gross_charge":1690.7500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids; except blood","code_information":[ { "code": "89050", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids; with diferencial count","code_information":[ { "code": "89051", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cellerate RX Surgical Activated","code_information":[ { "code": "270001149", "type": "APC" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"}]}]},{"description":"Central nervous system pathogen, includes multiplex reverse transcription, when performed, and mutiplex amplied probe technique, multiples types or subtypes, 12-25 targets","code_information":[ { "code": "87483", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0 fr\/5","code_information":[ { "code": "2708243", "type": "APC" } ],"standard_charges":[{"minimum":137.2000,"maximum":137.2000,"gross_charge":137.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0Fr\/5cm","code_information":[ { "code": "270000303", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0Fr\/8cm","code_information":[ { "code": "270000305", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 4.0Fr\/12cm","code_information":[ { "code": "270000307", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 5.0Fr\/15cm","code_information":[ { "code": "270000309", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000311", "type": "APC" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000313", "type": "APC" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"}]}]},{"description":"Cetacaine Topical Anesthetic Spray","code_information":[ { "code": "270001151", "type": "APC" } ],"standard_charges":[{"minimum":72.6500,"maximum":72.6500,"gross_charge":72.6500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"}]}]},{"description":"CFTR gene, analysis; common variants","code_information":[ { "code": "81220", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CG FUTURE Annuloplasty Ring 638R 24 mm","code_information":[ { "code": "3021046", "type": "APC" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"Chemiluminescent assay","code_information":[ { "code": "82397", "type": "APC" } ],"standard_charges":[{"minimum":80.0800,"maximum":80.0800,"gross_charge":80.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"}]}]},{"description":"Chlamydia","code_information":[ { "code": "86631", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chlamydia IgM","code_information":[ { "code": "86632", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chlamydia trachomatis; amplified Probe Technique","code_information":[ { "code": "87491", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride; blood","code_information":[ { "code": "82435", "type": "APC" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride; other source","code_information":[ { "code": "82438", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride; urine","code_information":[ { "code": "82436", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Cholesterol Body Fluid","code_information":[ { "code": "84265", "type": "APC" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Cholesterol, serum or whole blood, total","code_information":[ { "code": "82465", "type": "APC" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; count 5 cells, 1 Karyotype, with banding","code_information":[ { "code": "88261", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cidex OPA","code_information":[ { "code": "2702250", "type": "APC" } ],"standard_charges":[{"minimum":39.7300,"maximum":39.7300,"gross_charge":39.7300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"}]}]},{"description":"Citrate","code_information":[ { "code": "82507", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Claria MRI CRT-D SureScan DTMA1D1","code_information":[ { "code": "3019127", "type": "APC" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"}]}]},{"description":"Claria MRI QUAD CRT-D SureScan DTMA1Q1","code_information":[ { "code": "3019577", "type": "APC" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"}]}]},{"description":"Clostridioides Differential Tox A B","code_information":[ { "code": "87324", "type": "APC" } ],"standard_charges":[{"minimum":34.9400,"maximum":34.9400,"gross_charge":34.9400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"}]}]},{"description":"Clostridium difficile toxin","code_information":[ { "code": "87230", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Closure of median sternotomy separation with or without debridement (separate procedure)","code_information":[ { "code": "21750", "type": "APC" } ],"standard_charges":[{"minimum":925.2600,"maximum":925.2600,"gross_charge":925.2600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"}]}]},{"description":"Closure of single ventricular septal defect, with or without patch","code_information":[ { "code": "33681", "type": "APC" } ],"standard_charges":[{"minimum":2496.3400,"maximum":2496.3400,"gross_charge":2496.3400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity","code_information":[ { "code": "85300", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, antigen assy","code_information":[ { "code": "85301", "type": "APC" } ],"standard_charges":[{"minimum":168.0000,"maximum":168.0000,"gross_charge":168.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Activity","code_information":[ { "code": "85303", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Antigen","code_information":[ { "code": "85302", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein S Free","code_information":[ { "code": "85306", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clozapine","code_information":[ { "code": "80159", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CO- Set Room Temperature System","code_information":[ { "code": "2701461", "type": "APC" } ],"standard_charges":[{"minimum":37.8000,"maximum":37.8000,"gross_charge":37.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; activated","code_information":[ { "code": "85347", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT DR MRI SureScan DDPA2D4","code_information":[ { "code": "3019304", "type": "APC" } ],"standard_charges":[{"minimum":15393.0000,"maximum":15393.0000,"gross_charge":15393.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT HF CRT-D MRI SureScan","code_information":[ { "code": "3019873", "type": "APC" } ],"standard_charges":[{"minimum":16793.0000,"maximum":16793.0000,"gross_charge":16793.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT VR MRI Sure Scan DVPA2D4","code_information":[ { "code": "3019303", "type": "APC" } ],"standard_charges":[{"minimum":13993.0000,"maximum":13993.0000,"gross_charge":13993.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"}]}]},{"description":"Cocaine","code_information":[ { "code": "80353", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Coccidioides","code_information":[ { "code": "86635", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Coda Balloon Catheter, 9 Fr, 120 cm L","code_information":[ { "code": "270000321", "type": "APC" } ],"standard_charges":[{"minimum":826.0000,"maximum":826.0000,"gross_charge":826.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"}]}]},{"description":"Cold Agglutinin Screen","code_information":[ { "code": "86156", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"}]}]},{"description":"Cold Agglutinin Titer","code_information":[ { "code": "86157", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial, with removal of terminal ileum or ileocolostomy","code_information":[ { "code": "44160", "type": "APC" } ],"standard_charges":[{"minimum":1731.8700,"maximum":1731.8700,"gross_charge":1731.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with anastomosis","code_information":[ { "code": "44140", "type": "APC" } ],"standard_charges":[{"minimum":1841.4300,"maximum":1841.4300,"gross_charge":1841.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with coloproctostomy, with colostomy","code_information":[ { "code": "44146", "type": "APC" } ],"standard_charges":[{"minimum":2915.7800,"maximum":2915.7800,"gross_charge":2915.7800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with resection, with colostomy or ileostomy and creation of a mucofistula","code_information":[ { "code": "44144", "type": "APC" } ],"standard_charges":[{"minimum":2453.4300,"maximum":2453.4300,"gross_charge":2453.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with skin-level cecostomy or colostomy","code_information":[ { "code": "44141", "type": "APC" } ],"standard_charges":[{"minimum":2524.1200,"maximum":2524.1200,"gross_charge":2524.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy","code_information":[ { "code": "44150", "type": "APC" } ],"standard_charges":[{"minimum":2534.4800,"maximum":2534.4800,"gross_charge":2534.4800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"}]}]},{"description":"Collage cross links, any method","code_information":[ { "code": "82523", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Collection of capillary blood specimens","code_information":[ { "code": "36416", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "45378", "type": "APC" } ],"standard_charges":[{"minimum":250.0500,"maximum":250.0500,"gross_charge":250.0500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed, with biopsy, single or multiple","code_information":[ { "code": "45380", "type": "APC" } ],"standard_charges":[{"minimum":271.6400,"maximum":271.6400,"gross_charge":271.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"}]}]},{"description":"Colostomy or skin level cecostomy","code_information":[ { "code": "44320", "type": "APC" } ],"standard_charges":[{"minimum":1648.0200,"maximum":1648.0200,"gross_charge":1648.0200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"}]}]},{"description":"Column chromatography, including mass spectrometry, if performed, non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","code_information":[ { "code": "82542", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Compatibility test incubated technique","code_information":[ { "code": "86921", "type": "APC" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Compatibility test; Antiglobulin technique","code_information":[ { "code": "86922", "type": "APC" } ],"standard_charges":[{"minimum":102.0000,"maximum":102.0000,"gross_charge":102.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"Compatibility test; Immediate spin technique","code_information":[ { "code": "86920", "type": "APC" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"}]}]},{"description":"Complement; antigen, each component","code_information":[ { "code": "86160", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Complement; Total hemolytic CH50","code_information":[ { "code": "86162", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Complete Repair anomalous pulmonary venous return","code_information":[ { "code": "33730", "type": "APC" } ],"standard_charges":[{"minimum":2708.6800,"maximum":2708.6800,"gross_charge":2708.6800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect","code_information":[ { "code": "33697", "type": "APC" } ],"standard_charges":[{"minimum":2768.2800,"maximum":2768.2800,"gross_charge":2768.2800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of Fallot without pulmonary atresia","code_information":[ { "code": "33692", "type": "APC" } ],"standard_charges":[{"minimum":2630.6600,"maximum":2630.6600,"gross_charge":2630.6600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with rigth atrial pacing and recording, rigth ventricular pacing and recording, His bundle recording","code_information":[ { "code": "93620", "type": "APC" } ],"standard_charges":[{"minimum":9425.8500,"maximum":9425.8500,"gross_charge":9425.8500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"}]}]},{"description":"Comprehensive Metabolic Panel","code_information":[ { "code": "80053", "type": "APC" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdomen and pelvis with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74174", "type": "APC" } ],"standard_charges":[{"minimum":566.1500,"maximum":566.1500,"gross_charge":566.1500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74175", "type": "APC" } ],"standard_charges":[{"minimum":456.3300,"maximum":456.3300,"gross_charge":456.3300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and images postprogressing","code_information":[ { "code": "75635", "type": "APC" } ],"standard_charges":[{"minimum":582.5300,"maximum":582.5300,"gross_charge":582.5300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "71275", "type": "APC" } ],"standard_charges":[{"minimum":417.5900,"maximum":417.5900,"gross_charge":417.5900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70496", "type": "APC" } ],"standard_charges":[{"minimum":409.9600,"maximum":409.9600,"gross_charge":409.9600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts(when present), with contrast material, including 3D image postprocessing (including evalution of cardiac structure and morphology assessment of cardiac funtion, and evaluation of venuos structures, if performed)","code_information":[ { "code": "75574", "type": "APC" } ],"standard_charges":[{"minimum":456.0600,"maximum":456.0600,"gross_charge":456.0600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprocessing","code_information":[ { "code": "73706", "type": "APC" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70498", "type": "APC" } ],"standard_charges":[{"minimum":409.4900,"maximum":409.4900,"gross_charge":409.4900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, pelvis, with contrast material(s), include noncontrast images, if performed, and image postprogressing","code_information":[ { "code": "72191", "type": "APC" } ],"standard_charges":[{"minimum":453.9400,"maximum":453.9400,"gross_charge":453.9400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprogressing","code_information":[ { "code": "73206", "type": "APC" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"}]}]},{"description":"Computed tomography guidance for needle placement, (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","code_information":[ { "code": "77012", "type": "APC" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; with contrast material","code_information":[ { "code": "74177", "type": "APC" } ],"standard_charges":[{"minimum":454.4400,"maximum":454.4400,"gross_charge":454.4400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material","code_information":[ { "code": "74176", "type": "APC" } ],"standard_charges":[{"minimum":270.8300,"maximum":270.8300,"gross_charge":270.8300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and futher sections in one or both body regions","code_information":[ { "code": "74178", "type": "APC" } ],"standard_charges":[{"minimum":508.8700,"maximum":508.8700,"gross_charge":508.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; with contrast material","code_information":[ { "code": "74160", "type": "APC" } ],"standard_charges":[{"minimum":349.4700,"maximum":349.4700,"gross_charge":349.4700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material","code_information":[ { "code": "74150", "type": "APC" } ],"standard_charges":[{"minimum":202.2300,"maximum":202.2300,"gross_charge":202.2300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material followed by contrast material and futher sections","code_information":[ { "code": "74170", "type": "APC" } ],"standard_charges":[{"minimum":391.9900,"maximum":391.9900,"gross_charge":391.9900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; with contrast material","code_information":[ { "code": "72126", "type": "APC" } ],"standard_charges":[{"minimum":250.0300,"maximum":250.0300,"gross_charge":250.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; without contrast material","code_information":[ { "code": "72125", "type": "APC" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72127", "type": "APC" } ],"standard_charges":[{"minimum":293.0300,"maximum":293.0300,"gross_charge":293.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; with contrast material","code_information":[ { "code": "70460", "type": "APC" } ],"standard_charges":[{"minimum":218.9900,"maximum":218.9900,"gross_charge":218.9900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; without contrast material","code_information":[ { "code": "70450", "type": "APC" } ],"standard_charges":[{"minimum":156.9500,"maximum":156.9500,"gross_charge":156.9500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70470", "type": "APC" } ],"standard_charges":[{"minimum":257.6600,"maximum":257.6600,"gross_charge":257.6600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, heart, with contrast materials, for evaluate of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","code_information":[ { "code": "75572", "type": "APC" } ],"standard_charges":[{"minimum":335.3800,"maximum":335.3800,"gross_charge":335.3800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","code_information":[ { "code": "75571", "type": "APC" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; with contrast material","code_information":[ { "code": "73701", "type": "APC" } ],"standard_charges":[{"minimum":247.1800,"maximum":247.1800,"gross_charge":247.1800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material","code_information":[ { "code": "73700", "type": "APC" } ],"standard_charges":[{"minimum":191.3200,"maximum":191.3200,"gross_charge":191.3200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","code_information":[ { "code": "73702", "type": "APC" } ],"standard_charges":[{"minimum":289.7300,"maximum":289.7300,"gross_charge":289.7300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; with contrast material","code_information":[ { "code": "72132", "type": "APC" } ],"standard_charges":[{"minimum":250.5200,"maximum":250.5200,"gross_charge":250.5200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material","code_information":[ { "code": "72131", "type": "APC" } ],"standard_charges":[{"minimum":190.8500,"maximum":190.8500,"gross_charge":190.8500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72133", "type": "APC" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; with contrast material","code_information":[ { "code": "70487", "type": "APC" } ],"standard_charges":[{"minimum":225.2000,"maximum":225.2000,"gross_charge":225.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; without contrast material","code_information":[ { "code": "70486", "type": "APC" } ],"standard_charges":[{"minimum":189.9500,"maximum":189.9500,"gross_charge":189.9500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70488", "type": "APC" } ],"standard_charges":[{"minimum":274.3900,"maximum":274.3900,"gross_charge":274.3900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; with contrast material","code_information":[ { "code": "70481", "type": "APC" } ],"standard_charges":[{"minimum":268.2400,"maximum":268.2400,"gross_charge":268.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material","code_information":[ { "code": "70480", "type": "APC" } ],"standard_charges":[{"minimum":234.7100,"maximum":234.7100,"gross_charge":234.7100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70482", "type": "APC" } ],"standard_charges":[{"minimum":313.1200,"maximum":313.1200,"gross_charge":313.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; with contrast material(s)","code_information":[ { "code": "72193", "type": "APC" } ],"standard_charges":[{"minimum":343.3100,"maximum":343.3100,"gross_charge":343.3100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; without contrast material","code_information":[ { "code": "72192", "type": "APC" } ],"standard_charges":[{"minimum":197.0100,"maximum":197.0100,"gross_charge":197.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72194", "type": "APC" } ],"standard_charges":[{"minimum":378.6700,"maximum":378.6700,"gross_charge":378.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; with contrast material(s)","code_information":[ { "code": "70491", "type": "APC" } ],"standard_charges":[{"minimum":273.8700,"maximum":273.8700,"gross_charge":273.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material","code_information":[ { "code": "70490", "type": "APC" } ],"standard_charges":[{"minimum":222.2800,"maximum":222.2800,"gross_charge":222.2800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and futher sections","code_information":[ { "code": "70492", "type": "APC" } ],"standard_charges":[{"minimum":329.2400,"maximum":329.2400,"gross_charge":329.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; with contrast material","code_information":[ { "code": "72129", "type": "APC" } ],"standard_charges":[{"minimum":251.9300,"maximum":251.9300,"gross_charge":251.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; without contrast material","code_information":[ { "code": "72128", "type": "APC" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72130", "type": "APC" } ],"standard_charges":[{"minimum":295.9000,"maximum":295.9000,"gross_charge":295.9000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; with contrast material(s)","code_information":[ { "code": "71260", "type": "APC" } ],"standard_charges":[{"minimum":240.7400,"maximum":240.7400,"gross_charge":240.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material","code_information":[ { "code": "71250", "type": "APC" } ],"standard_charges":[{"minimum":191.5100,"maximum":191.5100,"gross_charge":191.5100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "71270", "type": "APC" } ],"standard_charges":[{"minimum":291.6200,"maximum":291.6200,"gross_charge":291.6200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; with contrast material(s)","code_information":[ { "code": "73201", "type": "APC" } ],"standard_charges":[{"minimum":299.7800,"maximum":299.7800,"gross_charge":299.7800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; without contrast material","code_information":[ { "code": "73200", "type": "APC" } ],"standard_charges":[{"minimum":240.1000,"maximum":240.1000,"gross_charge":240.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "73202", "type": "APC" } ],"standard_charges":[{"minimum":371.9800,"maximum":371.9800,"gross_charge":371.9800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"}]}]},{"description":"Confida Brecker Guideware 30mm X 260cm","code_information":[ { "code": "270001153", "type": "APC" } ],"standard_charges":[{"minimum":274.4000,"maximum":274.4000,"gross_charge":274.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"}]}]},{"description":"Confirm RX","code_information":[ { "code": "3019024", "type": "APC" } ],"standard_charges":[{"minimum":3480.0000,"maximum":3480.0000,"gross_charge":3480.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"}]}]},{"description":"Contegra 200 12mm (Model 200H12)","code_information":[ { "code": "2780680", "type": "APC" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Contour 3D 690R Annuloplasty Tricuspid","code_information":[ { "code": "2820125", "type": "APC" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Control nasal hemorrhage, anterior, complex (extensive cautery\/or packing) any method","code_information":[ { "code": "30903", "type": "APC" } ],"standard_charges":[{"minimum":107.1300,"maximum":107.1300,"gross_charge":107.1300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"}]}]},{"description":"Copper","code_information":[ { "code": "82525", "type": "APC" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, using arterial grafts; single arterial graft","code_information":[ { "code": "33533", "type": "APC" } ],"standard_charges":[{"minimum":2523.0000,"maximum":2523.0000,"gross_charge":2523.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 2 coronary venous graft","code_information":[ { "code": "33511", "type": "APC" } ],"standard_charges":[{"minimum":2860.4500,"maximum":2860.4500,"gross_charge":2860.4500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 3 coronary venous graft","code_information":[ { "code": "33512", "type": "APC" } ],"standard_charges":[{"minimum":3258.2500,"maximum":3258.2500,"gross_charge":3258.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 4 coronary venous graft","code_information":[ { "code": "33513", "type": "APC" } ],"standard_charges":[{"minimum":3354.4400,"maximum":3354.4400,"gross_charge":3354.4400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 5 coronary venous graft","code_information":[ { "code": "33514", "type": "APC" } ],"standard_charges":[{"minimum":3497.7000,"maximum":3497.7000,"gross_charge":3497.7000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; single coronary venous","code_information":[ { "code": "33510", "type": "APC" } ],"standard_charges":[{"minimum":2604.9500,"maximum":2604.9500,"gross_charge":2604.9500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"}]}]},{"description":"Coronary Care Unit (CCU)","code_information":[ { "code": "210000001", "type": "APC" } ],"standard_charges":[{"minimum":1919.4000,"maximum":759.0000,"gross_charge":1919.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"}]}]},{"description":"Coronary Ostial Perfusion Cannula #10","code_information":[ { "code": "3020680", "type": "APC" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Cortisol; free","code_information":[ { "code": "82530", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cortisol; total","code_information":[ { "code": "82533", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CPB Custom Perfusion Pack","code_information":[ { "code": "2740000", "type": "APC" } ],"standard_charges":[{"minimum":1285.2000,"maximum":1285.2000,"gross_charge":1285.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"}]}]},{"description":"C-peptide","code_information":[ { "code": "84681", "type": "APC" } ],"standard_charges":[{"minimum":83.2000,"maximum":83.2000,"gross_charge":83.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000025", "type": "APC" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000335", "type": "APC" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000337", "type": "APC" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000339", "type": "APC" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SLII Slittable Outer Guide","code_information":[ { "code": "270000027", "type": "APC" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct Universal Slittable Outer","code_information":[ { "code": "270000341", "type": "APC" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"Creatine Kinase (CK), (CPK); total","code_information":[ { "code": "82550", "type": "APC" } ],"standard_charges":[{"minimum":26.6000,"maximum":26.6000,"gross_charge":26.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creatinine; blood","code_information":[ { "code": "82565", "type": "APC" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"}]}]},{"description":"Creatinine; Clearance","code_information":[ { "code": "82575", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creatinine; other source","code_information":[ { "code": "82570", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creation of pericardial window or partial resection for drainage","code_information":[ { "code": "33025", "type": "APC" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"}]}]},{"description":"Cryo Aortic Heart Valve","code_information":[ { "code": "2710958", "type": "APC" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"}]}]},{"description":"Cryo Cryo Femoral Vein","code_information":[ { "code": "2820137", "type": "APC" } ],"standard_charges":[{"minimum":6619.2000,"maximum":6619.2000,"gross_charge":6619.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"}]}]},{"description":"Acylcarnitines; qualitative, each specimen","drug_information":{"unit":1.0000000000,"type":"ML"},"code_information":[ { "code": "82016", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Adrenocorticotropic Hormone","drug_information":{"unit":1.0000000000,"type":"ME"},"code_information":[ { "code": "82024", "type": "APC" } ],"standard_charges":[{"minimum":72.1000,"maximum":72.1000,"gross_charge":72.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Heart Valve","code_information":[ { "code": "2780235", "type": "APC" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Pact Thin","code_information":[ { "code": "3020837", "type": "APC" } ],"standard_charges":[{"minimum":8850.8000,"maximum":8850.8000,"gross_charge":8850.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Patch","code_information":[ { "code": "2770105", "type": "APC" } ],"standard_charges":[{"minimum":6112.4000,"maximum":6112.4000,"gross_charge":6112.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"}]}]},{"description":"Cryoglobulin, qualitative or sem-quantitative","code_information":[ { "code": "82595", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cryoprecipitate, each unit","code_information":[ { "code": "P9012", "type": "APC" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"Cryptococcus Cytomegalovirus (CMV) IgM","code_information":[ { "code": "86645", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Cryptococcus Cytomegalovirus IgG Antibody","code_information":[ { "code": "86644", "type": "APC" } ],"standard_charges":[{"minimum":23.8000,"maximum":23.8000,"gross_charge":23.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"}]}]},{"description":"Cryptosporidium Antigen Stool","code_information":[ { "code": "87328", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Crystal identification by light microscopy wit or without polarizing lens analysis, tissue or any body fluid","code_information":[ { "code": "89060", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; any other source except urine, blood or stool, aerobic with isolation and presumptive identification of isolates","code_information":[ { "code": "87070", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; blood aerobic with isolation and presumptive identification of isolates","code_information":[ { "code": "87040", "type": "APC" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; stool, aerobic with isolation and preliminary examination","code_information":[ { "code": "87045", "type": "APC" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate","code_information":[ { "code": "87046", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","code_information":[ { "code": "87077", "type": "APC" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; quantitative colony count, urine","code_information":[ { "code": "87086", "type": "APC" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; quantitative, aerobic with isolationand presumptive identification of isolates, any source except urine, blood or stool","code_information":[ { "code": "87071", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; other source","code_information":[ { "code": "87102", "type": "APC" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; Blood","code_information":[ { "code": "87103", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; skin, hair, or nail","code_information":[ { "code": "87101", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, fungi, definitive identification, each organism; yeast","code_information":[ { "code": "87106", "type": "APC" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, presumptive, pathogenic organism screening only","code_information":[ { "code": "87081", "type": "APC" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"Culture, tubercle or other acid-fast bacilli, any source, with isolative presumptive identification of isolates","code_information":[ { "code": "87116", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Curved Bipolar Dissector","code_information":[ { "code": "3021141", "type": "APC" } ],"standard_charges":[{"minimum":5556.6000,"maximum":5556.6000,"gross_charge":5556.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"}]}]},{"description":"Cyanocobalamin","code_information":[ { "code": "82607", "type": "APC" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"}]}]},{"description":"Cyclic Citrullinated Peptide, antibody","code_information":[ { "code": "86200", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cyclosporine","code_information":[ { "code": "80158", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CYP2C19 gene, analysis; common variants","code_information":[ { "code": "81225", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytolopathology, selective cellular enhancement technique with interpretation; except cervical or vaginal","code_information":[ { "code": "88112", "type": "APC" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytomegalovirus, amplified probe technique","code_information":[ { "code": "87496", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytomegalovirus, quantification","code_information":[ { "code": "87497", "type": "APC" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"}]}]},{"description":"Debridement subcutaneous tissue; first 20 sq cm or less","code_information":[ { "code": "11042", "type": "APC" } ],"standard_charges":[{"minimum":84.4600,"maximum":84.4600,"gross_charge":84.4600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"}]}]},{"description":"Debridment bone; first 20 sq cm or less","code_information":[ { "code": "11044", "type": "APC" } ],"standard_charges":[{"minimum":308.1400,"maximum":308.1400,"gross_charge":308.1400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forear and or wrist, flexor or exttensor compartment; without debridement of nonviable muscle and or nerve","code_information":[ { "code": "25020", "type": "APC" } ],"standard_charges":[{"minimum":1048.3200,"maximum":1048.3200,"gross_charge":1048.3200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"}]}]},{"description":"Decortication parietal pleurectomy","code_information":[ { "code": "32320", "type": "APC" } ],"standard_charges":[{"minimum":2179.1800,"maximum":2179.1800,"gross_charge":2179.1800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"}]}]},{"description":"Decortication, pulmonary partial","code_information":[ { "code": "32225", "type": "APC" } ],"standard_charges":[{"minimum":1352.7200,"maximum":1352.7200,"gross_charge":1352.7200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"}]}]},{"description":"Decortication, pulmonary total","code_information":[ { "code": "32220", "type": "APC" } ],"standard_charges":[{"minimum":2173.0700,"maximum":2173.0700,"gross_charge":2173.0700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"}]}]},{"description":"Dehydroepiandrosterone Sulfate (DHEA-S)","code_information":[ { "code": "82627", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Delivery Catheter C315HIS","code_information":[ { "code": "270000029", "type": "APC" } ],"standard_charges":[{"minimum":280.0000,"maximum":280.0000,"gross_charge":280.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"}]}]},{"description":"Deoxyribonuclease Antibody","code_information":[ { "code": "86215", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Dermabond Advanced 0.7 ML","code_information":[ { "code": "270000351", "type": "APC" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"Dermacea Sterile Gauzes 4'' X 4''","code_information":[ { "code": "270000353", "type": "APC" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"Dialisis","code_information":[ { "code": "90935", "type": "APC" } ],"standard_charges":[{"minimum":359.8000,"maximum":359.8000,"gross_charge":359.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"}]}]},{"description":"Diaphragm imbrication for eventration, transthoracic or transabdominal, paralytic or nonparalytic","code_information":[ { "code": "39545", "type": "APC" } ],"standard_charges":[{"minimum":1222.3300,"maximum":1222.3300,"gross_charge":1222.3300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"}]}]},{"description":"Diaphragma resection with simple repair","code_information":[ { "code": "39560", "type": "APC" } ],"standard_charges":[{"minimum":1102.6800,"maximum":1102.6800,"gross_charge":1102.6800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"}]}]},{"description":"Diffusion Membrane Oxigenator","code_information":[ { "code": "2702468", "type": "APC" } ],"standard_charges":[{"minimum":1164.3400,"maximum":1164.3400,"gross_charge":1164.3400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"}]}]},{"description":"Digoxin; total","code_information":[ { "code": "80162", "type": "APC" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"Diphtheria enterovirus","code_information":[ { "code": "86658", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage","code_information":[ { "code": "33645", "type": "APC" } ],"standard_charges":[{"minimum":2335.3800,"maximum":2335.3800,"gross_charge":2335.3800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)","code_information":[ { "code": "35141", "type": "APC" } ],"standard_charges":[{"minimum":1488.8600,"maximum":1488.8600,"gross_charge":1488.8600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"}]}]},{"description":"Disposable Cytology Brush","code_information":[ { "code": "270001157", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable (12ft)","code_information":[ { "code": "270000359", "type": "APC" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable (8ft)","code_information":[ { "code": "270000357", "type": "APC" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable 301-CG(1)","code_information":[ { "code": "270000031", "type": "APC" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy, thoracic approach","code_information":[ { "code": "43135", "type": "APC" } ],"standard_charges":[{"minimum":1992.2700,"maximum":1992.2700,"gross_charge":1992.2700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"}]}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy; cervical approach","code_information":[ { "code": "43130", "type": "APC" } ],"standard_charges":[{"minimum":1097.1200,"maximum":1097.1200,"gross_charge":1097.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"}]}]},{"description":"DNA Antibody; native or double stranded","code_information":[ { "code": "86225", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Dormo-Strip","code_information":[ { "code": "270000361", "type": "APC" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"Double Lumen 28 LT","code_information":[ { "code": "2703245", "type": "APC" } ],"standard_charges":[{"minimum":116.4800,"maximum":116.4800,"gross_charge":116.4800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"}]}]},{"description":"Double Transducer","code_information":[ { "code": "2712110", "type": "APC" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Drainage of a retroperitoneal abscess, open","code_information":[ { "code": "49060", "type": "APC" } ],"standard_charges":[{"minimum":1528.8000,"maximum":1528.8000,"gross_charge":1528.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"}]}]},{"description":"Drainage of Finger abscess; simple","code_information":[ { "code": "26010", "type": "APC" } ],"standard_charges":[{"minimum":200.9600,"maximum":200.9600,"gross_charge":200.9600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"}]}]},{"description":"Drainage of peritoneal abscess or localized peritonitis, exclusive appendiceal abscess, open","code_information":[ { "code": "49020", "type": "APC" } ],"standard_charges":[{"minimum":2226.6900,"maximum":2226.6900,"gross_charge":2226.6900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"}]}]},{"description":"Drug test presumptive any number of drug classes, any number of devices or procedures; By instrument chemistry analyzers","code_information":[ { "code": "80307", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of extracranial arteries; complete bilateral study","code_information":[ { "code": "93880", "type": "APC" } ],"standard_charges":[{"minimum":267.1200,"maximum":267.1200,"gross_charge":267.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of extracranial arteries; unilateral or limited study","code_information":[ { "code": "93882", "type": "APC" } ],"standard_charges":[{"minimum":175.2500,"maximum":175.2500,"gross_charge":175.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"}]}]},{"description":"Durata Defibrillation Lead 58 cm","code_information":[ { "code": "2790576", "type": "APC" } ],"standard_charges":[{"minimum":2366.0000,"maximum":2366.0000,"gross_charge":2366.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endopath Staple Line","code_information":[ { "code": "270001161", "type": "APC" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021060", "type": "APC" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021061", "type": "APC" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":194.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021095", "type": "APC" } ],"standard_charges":[{"minimum":232.4000,"maximum":232.4000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001167", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":170.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001171", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":194.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001173", "type": "APC" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001175", "type": "APC" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":170.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001177", "type": "APC" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001179", "type": "APC" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex 45 Articulating","code_information":[ { "code": "270000373", "type": "APC" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Echelon flex powered plus articulating","code_information":[ { "code": "270000375", "type": "APC" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex Powered Plus Compact","code_information":[ { "code": "270000377", "type": "APC" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex Powered Vascular Stapler","code_information":[ { "code": "270000379", "type": "APC" } ],"standard_charges":[{"minimum":595.0000,"maximum":595.0000,"gross_charge":595.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon-Flex 60 Articulating","code_information":[ { "code": "270000381", "type": "APC" } ],"standard_charges":[{"minimum":441.0000,"maximum":441.0000,"gross_charge":441.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when preformed, during rest and cardiovascular stress test using treadmill, bicycle exercise and\/or pharmacologically induce stress, with interpretation and report; including performance of continuos electrocardiographic monitoring, with supervision by a physician or other qualified health care professional","code_information":[ { "code": "93351", "type": "APC" } ],"standard_charges":[{"minimum":330.6200,"maximum":330.6200,"gross_charge":330.6200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"}]}]},{"description":"Ecmo Membrane","code_information":[ { "code": "2780060", "type": "APC" } ],"standard_charges":[{"minimum":1176.0000,"maximum":1176.0000,"gross_charge":1176.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"}]}]},{"description":"Ecmo Tubing Pack (Pediatric)","code_information":[ { "code": "2780061", "type": "APC" } ],"standard_charges":[{"minimum":1052.8000,"maximum":1052.8000,"gross_charge":1052.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System","code_information":[ { "code": "270000385", "type": "APC" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 20mm","code_information":[ { "code": "270000383", "type": "APC" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 26mm","code_information":[ { "code": "270000387", "type": "APC" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 29mm","code_information":[ { "code": "270000389", "type": "APC" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Crimper","code_information":[ { "code": "270001181", "type": "APC" } ],"standard_charges":[{"minimum":469.0000,"maximum":469.0000,"gross_charge":469.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards eSheath+Introducer Set","code_information":[ { "code": "2705070", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001373", "type": "APC" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001375", "type": "APC" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001377", "type": "APC" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001379", "type": "APC" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"EEA OrVil Auto Suture Transoral","code_information":[ { "code": "2760736", "type": "APC" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"}]}]},{"description":"Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report","code_information":[ { "code": "93000", "type": "APC" } ],"standard_charges":[{"minimum":19.7700,"maximum":19.7700,"gross_charge":19.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"}]}]},{"description":"Electrode Multifunction Pediatric","code_information":[ { "code": "2700902", "type": "APC" } ],"standard_charges":[{"minimum":57.4000,"maximum":57.4000,"gross_charge":57.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"}]}]},{"description":"Electrolytes panel","code_information":[ { "code": "80051", "type": "APC" } ],"standard_charges":[{"minimum":22.6100,"maximum":22.6100,"gross_charge":22.6100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Electrophysiologic evaluation with treatment of supraventricular tachycardia","code_information":[ { "code": "93653", "type": "APC" } ],"standard_charges":[{"minimum":1118.5600,"maximum":1118.5600,"gross_charge":1118.5600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"}]}]},{"description":"Electrophysiologic evaluation with treatment of ventricular tachycardia or focus of ventricular ectopy","code_information":[ { "code": "93654", "type": "APC" } ],"standard_charges":[{"minimum":1347.5800,"maximum":1347.5800,"gross_charge":1347.5800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"}]}]},{"description":"Ellipse DR Implantable Cardioverter","code_information":[ { "code": "3019129", "type": "APC" } ],"standard_charges":[{"minimum":11905.6000,"maximum":11905.6000,"gross_charge":11905.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"}]}]},{"description":"Ellipse VR Implantable Cardioverter","code_information":[ { "code": "30170052", "type": "APC" } ],"standard_charges":[{"minimum":10294.2000,"maximum":10294.2000,"gross_charge":10294.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"}]}]},{"description":"Emblem MRI S-ICD A219","code_information":[ { "code": "3017232", "type": "APC" } ],"standard_charges":[{"minimum":18816.0000,"maximum":18816.0000,"gross_charge":18816.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"}]}]},{"description":"Emblem S-ICD 3501 45 CM","code_information":[ { "code": "3017470", "type": "APC" } ],"standard_charges":[{"minimum":2688.0000,"maximum":2688.0000,"gross_charge":2688.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter, carotid, subclavian or innominate artery, by neck incision","code_information":[ { "code": "34001", "type": "APC" } ],"standard_charges":[{"minimum":1227.7200,"maximum":1227.7200,"gross_charge":1227.7200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"}]}]},{"description":"Emerald Guidewire","code_information":[ { "code": "270000401", "type": "APC" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Emergency Shunt Kit","code_information":[ { "code": "2706608", "type": "APC" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"}]}]},{"description":"Encore 26 Advantage Kit Inflation","code_information":[ { "code": "270000403", "type": "APC" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"}]}]},{"description":"Endo Catch Specimen Retrieval Pouch 15","code_information":[ { "code": "3021169", "type": "APC" } ],"standard_charges":[{"minimum":630.0000,"maximum":630.0000,"gross_charge":630.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Articulating ref. egia45amt","code_information":[ { "code": "2800827", "type": "APC" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Articulating ref. egia45avt","code_information":[ { "code": "2800995", "type": "APC" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Ultra Universal Stapler 12mm","code_information":[ { "code": "2800826", "type": "APC" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"ENDO- SURGERY LINEAR STAPLER RELOAD","code_information":[ { "code": "270001183", "type": "APC" } ],"standard_charges":[{"minimum":81.2500,"maximum":81.2500,"gross_charge":81.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"}]}]},{"description":"Endomyocardial Biopsy","code_information":[ { "code": "93505", "type": "APC" } ],"standard_charges":[{"minimum":880.4000,"maximum":880.4000,"gross_charge":880.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"}]}]},{"description":"Endomysial Antibody, each immunoglobulin","code_information":[ { "code": "86231", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000407", "type": "APC" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000409", "type": "APC" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign bodies or stents from the biliary\/pancreatic ducts","code_information":[ { "code": "43275", "type": "APC" } ],"standard_charges":[{"minimum":516.3200,"maximum":516.3200,"gross_charge":516.3200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Cutter Reloads","code_information":[ { "code": "270001185", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001187", "type": "APC" } ],"standard_charges":[{"minimum":82.8700,"maximum":82.8700,"gross_charge":82.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001189", "type": "APC" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":82.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"ENDO-SURGERY LINEAR STAPLER RELOADS","code_information":[ { "code": "270001191", "type": "APC" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001193", "type": "APC" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001195", "type": "APC" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of the descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic discruption); involving the coverage of the left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s) if required, to level of celiac artery origin","code_information":[ { "code": "33880", "type": "APC" } ],"standard_charges":[{"minimum":2431.4900,"maximum":2431.4900,"gross_charge":2431.4900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"}]}]},{"description":"Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches","code_information":[ { "code": "33894", "type": "APC" } ],"standard_charges":[{"minimum":1314.6300,"maximum":1314.6300,"gross_charge":1314.6300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"}]}]},{"description":"Endovenous ablation therapy of incompetent vein in an extremity using radiofrequency for the first vein treated","code_information":[ { "code": "36475", "type": "APC" } ],"standard_charges":[{"minimum":373.2100,"maximum":373.2100,"gross_charge":373.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity; by transcatheter delivery of a chemical adhesive remote form the access site, inclusive of all imging guidacne and monitoring percutaneous; first vein treated","code_information":[ { "code": "36482", "type": "APC" } ],"standard_charges":[{"minimum":240.8700,"maximum":240.8700,"gross_charge":240.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Instruments Suction","code_information":[ { "code": "3021115", "type": "APC" } ],"standard_charges":[{"minimum":389.6700,"maximum":389.6700,"gross_charge":389.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Stapler Gray 30mm 2.0mm","code_information":[ { "code": "3021145", "type": "APC" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Stapler White 30mm 2.5mm","code_information":[ { "code": "3021143", "type": "APC" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"}]}]},{"description":"Endozime Sponge","code_information":[ { "code": "270001199", "type": "APC" } ],"standard_charges":[{"minimum":322.0000,"maximum":322.0000,"gross_charge":322.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"}]}]},{"description":"Endurant II Stent Graft System Limb","code_information":[ { "code": "2740173", "type": "APC" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"}]}]},{"description":"Enhance Transcarotid Peripheral Access","code_information":[ { "code": "3021036", "type": "APC" } ],"standard_charges":[{"minimum":2646.0000,"maximum":2646.0000,"gross_charge":2646.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"}]}]},{"description":"Enroute Enflate Transcarotid 5.5x25","code_information":[ { "code": "3021039", "type": "APC" } ],"standard_charges":[{"minimum":530.6000,"maximum":530.6000,"gross_charge":530.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid 0.014 Guidewires","code_information":[ { "code": "3021035", "type": "APC" } ],"standard_charges":[{"minimum":1477.0000,"maximum":1477.0000,"gross_charge":1477.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Neuroprotection","code_information":[ { "code": "3021034", "type": "APC" } ],"standard_charges":[{"minimum":5248.6000,"maximum":5248.6000,"gross_charge":5248.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021037", "type": "APC" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021038", "type": "APC" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"}]}]},{"description":"Enseal X1 Large Jaw Tissue Sealer 20","code_information":[ { "code": "270000423", "type": "APC" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Ensemble II Transcatheter Valve","code_information":[ { "code": "3019046", "type": "APC" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"}]}]},{"description":"Enterovirus, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87498", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive subtrate, each specimen","code_information":[ { "code": "82657", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Epstein","code_information":[ { "code": "86665", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Epstein Barr Virus Early Antigen Antibody","code_information":[ { "code": "86663", "type": "APC" } ],"standard_charges":[{"minimum":90.0100,"maximum":90.0100,"gross_charge":90.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"}]}]},{"description":"Epstein-Barr Virus Nuclear Antigen Antibody","code_information":[ { "code": "86664", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Esophagectomy, distal two-thirds, , with laparospic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43287", "type": "APC" } ],"standard_charges":[{"minimum":4813.5500,"maximum":4813.5500,"gross_charge":4813.5500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"}]}]},{"description":"Esophagectomy, total or near total, with laparospic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43286", "type": "APC" } ],"standard_charges":[{"minimum":4308.1900,"maximum":4308.1900,"gross_charge":4308.1900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"}]}]},{"description":"Esophagectomy, total or near total, with thoracospic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparospic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43288", "type": "APC" } ],"standard_charges":[{"minimum":5160.8200,"maximum":5160.8200,"gross_charge":5160.8200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"}]}]},{"description":"Esophagogastric fundoplasty partial or complete; laparotomy","code_information":[ { "code": "43327", "type": "APC" } ],"standard_charges":[{"minimum":1141.5300,"maximum":1141.5300,"gross_charge":1141.5300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy with directed placement of percutaneous gastrostomy tube","code_information":[ { "code": "43246", "type": "APC" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with band ligation of esophageal\/gastric varices","code_information":[ { "code": "43244", "type": "APC" } ],"standard_charges":[{"minimum":336.8000,"maximum":336.8000,"gross_charge":336.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "43235", "type": "APC" } ],"standard_charges":[{"minimum":169.3700,"maximum":169.3700,"gross_charge":169.3700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with biopsy, single or multiple","code_information":[ { "code": "43239", "type": "APC" } ],"standard_charges":[{"minimum":188.1600,"maximum":188.1600,"gross_charge":188.1600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with control of bleeding, any method","code_information":[ { "code": "43255", "type": "APC" } ],"standard_charges":[{"minimum":270.7500,"maximum":270.7500,"gross_charge":270.7500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with dilation of gastric\/duodenal stricture(s)","code_information":[ { "code": "43245", "type": "APC" } ],"standard_charges":[{"minimum":238.1000,"maximum":238.1000,"gross_charge":238.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire","code_information":[ { "code": "43248", "type": "APC" } ],"standard_charges":[{"minimum":229.0500,"maximum":229.0500,"gross_charge":229.0500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with placement of an endoscopic stent","code_information":[ { "code": "43266", "type": "APC" } ],"standard_charges":[{"minimum":294.5200,"maximum":294.5200,"gross_charge":294.5200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with removal of foreign body(s)","code_information":[ { "code": "43247", "type": "APC" } ],"standard_charges":[{"minimum":239.5100,"maximum":239.5100,"gross_charge":239.5100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with transendoscopic balloon dilation of the esophagus (less than 30 mm in diameter)","code_information":[ { "code": "43249", "type": "APC" } ],"standard_charges":[{"minimum":208.3300,"maximum":208.3300,"gross_charge":208.3300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"}]}]},{"description":"Esophagomyotomy (heller type); thoracic approach","code_information":[ { "code": "43331", "type": "APC" } ],"standard_charges":[{"minimum":1821.9700,"maximum":1821.9700,"gross_charge":1821.9700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with insertion of guide wire followed by passage of dilator(s) over guide wire","code_information":[ { "code": "43226", "type": "APC" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with removal of foreign body(s)","code_information":[ { "code": "43215", "type": "APC" } ],"standard_charges":[{"minimum":192.2100,"maximum":192.2100,"gross_charge":192.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with transendoscopic balloon dilation","code_information":[ { "code": "43220", "type": "APC" } ],"standard_charges":[{"minimum":160.6200,"maximum":160.6200,"gross_charge":160.6200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimens by brushing or washing, when performed","code_information":[ { "code": "43200", "type": "APC" } ],"standard_charges":[{"minimum":120.2300,"maximum":120.2300,"gross_charge":120.2300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus, with cricopharyngeal myotomy, includes use of telescope or oparating microscope and repair","code_information":[ { "code": "43180", "type": "APC" } ],"standard_charges":[{"minimum":767.4800,"maximum":767.4800,"gross_charge":767.4800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen((s) by brushing or washing when preformed","code_information":[ { "code": "43191", "type": "APC" } ],"standard_charges":[{"minimum":213.8800,"maximum":213.8800,"gross_charge":213.8800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with balloon dilation (less than 30mm diameter)","code_information":[ { "code": "43195", "type": "APC" } ],"standard_charges":[{"minimum":254.2400,"maximum":254.2400,"gross_charge":254.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with biopsy, single or multiple","code_information":[ { "code": "43202", "type": "APC" } ],"standard_charges":[{"minimum":140.4500,"maximum":140.4500,"gross_charge":140.4500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed","code_information":[ { "code": "43212", "type": "APC" } ],"standard_charges":[{"minimum":255.8600,"maximum":255.8600,"gross_charge":255.8600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"}]}]},{"description":"Esophagostomy, fistulization of esophagus, external; cervical approach","code_information":[ { "code": "43352", "type": "APC" } ],"standard_charges":[{"minimum":1456.3100,"maximum":1456.3100,"gross_charge":1456.3100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"}]}]},{"description":"Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode(s) placement, recording, analysis and interpretation","code_information":[ { "code": "91034", "type": "APC" } ],"standard_charges":[{"minimum":268.9700,"maximum":268.9700,"gross_charge":268.9700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"}]}]},{"description":"Estrogens; Total","code_information":[ { "code": "82672", "type": "APC" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel Polter Suture 2-0","code_information":[ { "code": "270000429", "type": "APC" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel SH Polter Suture 2-0","code_information":[ { "code": "270000431", "type": "APC" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000437", "type": "APC" } ],"standard_charges":[{"minimum":46.0800,"maximum":46.0800,"gross_charge":46.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000439", "type": "APC" } ],"standard_charges":[{"minimum":33.4700,"maximum":33.4700,"gross_charge":46.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000441", "type": "APC" } ],"standard_charges":[{"minimum":149.1100,"maximum":149.1100,"gross_charge":46.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-7 Polter Suture","code_information":[ { "code": "270000443", "type": "APC" } ],"standard_charges":[{"minimum":178.9300,"maximum":178.9300,"gross_charge":178.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Linear Cutter","code_information":[ { "code": "3018401", "type": "APC" } ],"standard_charges":[{"minimum":161.0000,"maximum":161.0000,"gross_charge":161.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Proximate Linear","code_information":[ { "code": "270001209", "type": "APC" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":86.0300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable","code_information":[ { "code": "270001217", "type": "APC" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001211", "type": "APC" } ],"standard_charges":[{"minimum":93.2200,"maximum":93.2200,"gross_charge":93.2200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001213", "type": "APC" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":93.2200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Enseal X1 Shears Integrated 25","code_information":[ { "code": "270000445", "type": "APC" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Ethicon Harmonic 1,100 Shears","code_information":[ { "code": "3019606", "type": "APC" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"}]}]},{"description":"Ethosuximide","code_information":[ { "code": "80168", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ethylene Glycol","code_information":[ { "code": "82693", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Evera MRI XT DR SureScan DDMB1D1","code_information":[ { "code": "2800870", "type": "APC" } ],"standard_charges":[{"minimum":21966.0000,"maximum":21966.0000,"gross_charge":21966.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Delivery Catheter System","code_information":[ { "code": "270001219", "type": "APC" } ],"standard_charges":[{"minimum":2240.0000,"maximum":2240.0000,"gross_charge":2240.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Delivery System 34 mm","code_information":[ { "code": "270001221", "type": "APC" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Loading System 23-29mm","code_information":[ { "code": "270000459", "type": "APC" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Loading System 34mm","code_information":[ { "code": "270001357", "type": "APC" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020638", "type": "APC" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020639", "type": "APC" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020640", "type": "APC" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020641", "type": "APC" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Excision brancial cleft cyst or vestige, confined to skin and subcutaneous tissues","code_information":[ { "code": "42810", "type": "APC" } ],"standard_charges":[{"minimum":401.9100,"maximum":401.9100,"gross_charge":401.9100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"}]}]},{"description":"Excision chest wall tumor involving rib, with plastic reconstruction; without mediastinal lymphadenectomy","code_information":[ { "code": "21602", "type": "APC" } ],"standard_charges":[{"minimum":2105.1100,"maximum":2105.1100,"gross_charge":2105.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"}]}]},{"description":"Excision Foreign Body, foot; deep","code_information":[ { "code": "28192", "type": "APC" } ],"standard_charges":[{"minimum":438.1000,"maximum":438.1000,"gross_charge":438.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"}]}]},{"description":"Excision Ganglion, wrist (dorsal or volar); primary","code_information":[ { "code": "25111", "type": "APC" } ],"standard_charges":[{"minimum":461.5700,"maximum":461.5700,"gross_charge":461.5700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"}]}]},{"description":"Excision of an infected graft; neck","code_information":[ { "code": "35901", "type": "APC" } ],"standard_charges":[{"minimum":655.1300,"maximum":655.1300,"gross_charge":655.1300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"}]}]},{"description":"Excision of chest wall tumor including\/involving rib(s)","code_information":[ { "code": "21601", "type": "APC" } ],"standard_charges":[{"minimum":1579.9400,"maximum":1579.9400,"gross_charge":1579.9400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"}]}]},{"description":"Excision of coarctation of the aorta, with or without associated patent ductus arteriosus, with direct anastomosis","code_information":[ { "code": "33840", "type": "APC" } ],"standard_charges":[{"minimum":1710.6000,"maximum":1710.6000,"gross_charge":1710.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"}]}]},{"description":"Excision of intracardiac tumor, resection with cardiopulmonary bypass","code_information":[ { "code": "33120", "type": "APC" } ],"standard_charges":[{"minimum":2860.9600,"maximum":2860.9600,"gross_charge":2860.9600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion, esophagus with primary repair; thoracic or abdominal approach","code_information":[ { "code": "43101", "type": "APC" } ],"standard_charges":[{"minimum":1370.8900,"maximum":1370.8900,"gross_charge":1370.8900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot","code_information":[ { "code": "28090", "type": "APC" } ],"standard_charges":[{"minimum":437.2200,"maximum":437.2200,"gross_charge":437.2200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"}]}]},{"description":"Excision of rib, partial","code_information":[ { "code": "21600", "type": "APC" } ],"standard_charges":[{"minimum":788.8200,"maximum":788.8200,"gross_charge":788.8200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"}]}]},{"description":"Excision of synovial cyst of popliteal space (Baker's Cyst)","code_information":[ { "code": "27345", "type": "APC" } ],"standard_charges":[{"minimum":684.4700,"maximum":684.4700,"gross_charge":684.4700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"}]}]},{"description":"Excision of tracheal tumor or carcinoma; cervical","code_information":[ { "code": "31785", "type": "APC" } ],"standard_charges":[{"minimum":1502.9300,"maximum":1502.9300,"gross_charge":1502.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"}]}]},{"description":"Excision tracheal stenosis and anastomosis; cervical","code_information":[ { "code": "31780", "type": "APC" } ],"standard_charges":[{"minimum":1651.2700,"maximum":1651.2700,"gross_charge":1651.2700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia","code_information":[ { "code": "11420", "type": "APC" } ],"standard_charges":[{"minimum":115.9300,"maximum":115.9300,"gross_charge":115.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less","code_information":[ { "code": "11400", "type": "APC" } ],"standard_charges":[{"minimum":117.2900,"maximum":117.2900,"gross_charge":117.2900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"}]}]},{"description":"Exploratory","code_information":[ { "code": "44910", "type": "APC" } ],"standard_charges":[{"minimum":1286.1000,"maximum":1286.1000,"gross_charge":1286.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"}]}]},{"description":"Exploratory Laparotomy, exploratory celiotomy with or without biopsy(s)","code_information":[ { "code": "49000", "type": "APC" } ],"standard_charges":[{"minimum":1076.5300,"maximum":1076.5300,"gross_charge":1076.5300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"}]}]},{"description":"Extractable nuclear antigen, antibody to, any method, each antibody","code_information":[ { "code": "86235", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Eye Acu.Dispo.Cautery High Temperature","code_information":[ { "code": "270001223", "type": "APC" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"F2 gene analysis 20210G>A variant","code_information":[ { "code": "81240", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"F5 gene analysis, Leiden variant","code_information":[ { "code": "81241", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"F9 full gene sequence","code_information":[ { "code": "81238", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualitatives","code_information":[ { "code": "82705", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualititative","code_information":[ { "code": "82710", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fatty acids, nonesterified","code_information":[ { "code": "82725", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Felbamate","code_information":[ { "code": "80167", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Femoral Angiography (Bundle)","code_information":[ { "code": "270000469", "type": "APC" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"}]}]},{"description":"Femoral Artery Catheter Set 4.0","code_information":[ { "code": "270000471", "type": "APC" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"}]}]},{"description":"Fenestrated Bipolar Forceps","code_information":[ { "code": "3021118", "type": "APC" } ],"standard_charges":[{"minimum":4116.0000,"maximum":4116.0000,"gross_charge":4116.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"}]}]},{"description":"Ferritin","code_information":[ { "code": "82728", "type": "APC" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"}]}]},{"description":"Fetal congenital abnormalities, biochemical assys of three proteins, utilizing maternal serum, algorithm reported as a risk score","code_information":[ { "code": "81509", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative","code_information":[ { "code": "82731", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative","code_information":[ { "code": "85379", "type": "APC" } ],"standard_charges":[{"minimum":42.2200,"maximum":42.2200,"gross_charge":42.2200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative or semiquantitative","code_information":[ { "code": "85378", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products; agglutination slide, semiquantitative","code_information":[ { "code": "85362", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrinogen; activity","code_information":[ { "code": "85384", "type": "APC" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Finishing Wire Supportrak Model 6668","code_information":[ { "code": "270000473", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Fixation Tool (Model 6616)","code_information":[ { "code": "270000475", "type": "APC" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"Flexor Check-Flo Introducer Set 8Fr","code_information":[ { "code": "270000477", "type": "APC" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":364.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"}]}]},{"description":"Fluid Trap Minivac Smk Evac","code_information":[ { "code": "3019903", "type": "APC" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"}]}]},{"description":"Fluorescent noninfectious agent antibody; screen, each antibody","code_information":[ { "code": "86255", "type": "APC" } ],"standard_charges":[{"minimum":103.8400,"maximum":103.8400,"gross_charge":103.8400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"FMR1 gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81243", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"FOB Trans Needle Aspiration","code_information":[ { "code": "31639", "type": "APC" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"outpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"}]}]},{"description":"Fogarty #2F","code_information":[ { "code": "270001227", "type": "APC" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #3F","code_information":[ { "code": "270001229", "type": "APC" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #4F","code_information":[ { "code": "270001231", "type": "APC" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #5F","code_information":[ { "code": "270001233", "type": "APC" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #6F","code_information":[ { "code": "270001235", "type": "APC" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Folic acid; serum","code_information":[ { "code": "82746", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Freestyle 995 Bioprosthesis Aortic","code_information":[ { "code": "2702926", "type": "APC" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma (single donor) each unit requisitioned to be AB positive","code_information":[ { "code": "P9017", "type": "APC" } ],"standard_charges":[{"minimum":85.0000,"maximum":85.0000,"gross_charge":85.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma between 8-24 hours of collection, each unit","code_information":[ { "code": "P9059", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma, thawing, each unit","code_information":[ { "code": "86927", "type": "APC" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Full access underbody 3M Bair hugger","code_information":[ { "code": "270000513", "type": "APC" } ],"standard_charges":[{"minimum":37.1000,"maximum":37.1000,"gross_charge":37.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"}]}]},{"description":"Full Access Underbody Adult","code_information":[ { "code": "270000515", "type": "APC" } ],"standard_charges":[{"minimum":48.3700,"maximum":48.3700,"gross_charge":48.3700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"}]}]},{"description":"Fullthickness graft free incluiding direct closure of donor site; trunk; 20 sq cm or less","code_information":[ { "code": "15200", "type": "APC" } ],"standard_charges":[{"minimum":929.9600,"maximum":929.9600,"gross_charge":929.9600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"}]}]},{"description":"Gabapentin, whole blood, serum or plasma","code_information":[ { "code": "80171", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Galactose 1 Phosphate uridyl transferase; quantitative","code_information":[ { "code": "82775", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gallant HF CRT-D","code_information":[ { "code": "3019745", "type": "APC" } ],"standard_charges":[{"minimum":16258.2000,"maximum":16258.2000,"gross_charge":16258.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"}]}]},{"description":"Gammaglobulin; IgA, IgD, IgG, IgM, each","code_information":[ { "code": "82784", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"}]}]},{"description":"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO15","code_information":[ { "code": "82803", "type": "APC" } ],"standard_charges":[{"minimum":52.0000,"maximum":52.0000,"gross_charge":52.0000,"setting":"outpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"}]}]},{"description":"Gastrectomy, total; with esophagoenterostomy","code_information":[ { "code": "43620", "type": "APC" } ],"standard_charges":[{"minimum":2717.8500,"maximum":2717.8500,"gross_charge":2717.8500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"}]}]},{"description":"Gastrointestinal Pathogen; includes multiplex reserve transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets","code_information":[ { "code": "87507", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Feeding Tube 12Fr","code_information":[ { "code": "270001237", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Feeding Tube 24 Fr","code_information":[ { "code": "270001239", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Tube Feeding 14Fr","code_information":[ { "code": "2770971", "type": "APC" } ],"standard_charges":[{"minimum":75.1800,"maximum":75.1800,"gross_charge":75.1800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy, open; without construction of gastric tube","code_information":[ { "code": "43830", "type": "APC" } ],"standard_charges":[{"minimum":971.6400,"maximum":971.6400,"gross_charge":971.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"}]}]},{"description":"Gastrotomy, with exploration or foreign body removal","code_information":[ { "code": "43500", "type": "APC" } ],"standard_charges":[{"minimum":1103.3800,"maximum":1103.3800,"gross_charge":1103.3800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"}]}]},{"description":"GDWR CGRXT190HS Cougar XT 5PK 190 ST","code_information":[ { "code": "2750403", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Gentamicin","code_information":[ { "code": "80170", "type": "APC" } ],"standard_charges":[{"minimum":36.4000,"maximum":36.4000,"gross_charge":36.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"}]}]},{"description":"Gliadin antibody, each immunoglobulin Ig class","code_information":[ { "code": "86258", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glide Scope BFlex 3.8","code_information":[ { "code": "3021309", "type": "APC" } ],"standard_charges":[{"minimum":442.4000,"maximum":442.4000,"gross_charge":442.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"}]}]},{"description":"Glide Sheath Basic 5fr\/100cm","code_information":[ { "code": "2820986", "type": "APC" } ],"standard_charges":[{"minimum":110.6000,"maximum":110.6000,"gross_charge":110.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"}]}]},{"description":"Glidecath Angled Taper 5Fr\/100cm","code_information":[ { "code": "270000517", "type": "APC" } ],"standard_charges":[{"minimum":61.1700,"maximum":61.1700,"gross_charge":61.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath Size 14F","code_information":[ { "code": "270000519", "type": "APC" } ],"standard_charges":[{"minimum":3391.5000,"maximum":3391.5000,"gross_charge":3391.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath, 12F","code_information":[ { "code": "270000521", "type": "APC" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath, 16F","code_information":[ { "code": "270000523", "type": "APC" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"}]}]},{"description":"GLIDESHEAT Hydrophilic Coated","code_information":[ { "code": "270000525", "type": "APC" } ],"standard_charges":[{"minimum":92.4000,"maximum":92.4000,"gross_charge":92.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"}]}]},{"description":"Glideware Advantage","code_information":[ { "code": "270000527", "type": "APC" } ],"standard_charges":[{"minimum":301.0000,"maximum":301.0000,"gross_charge":301.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"}]}]},{"description":"Glidewire Cath. Exchange","code_information":[ { "code": "270000529", "type": "APC" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"}]}]},{"description":"Glucagon","code_information":[ { "code": "82943", "type": "APC" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose Tolerance test (GTT), 3 specimens (including glucose)","code_information":[ { "code": "82951", "type": "APC" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose, body fluid, other than blood","code_information":[ { "code": "82945", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"}]}]},{"description":"Glucose; quantitative, blood","code_information":[ { "code": "82947", "type": "APC" } ],"standard_charges":[{"minimum":48.0100,"maximum":48.0100,"gross_charge":48.0100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose-6-Phosphate Dehydrogen (G6PD); quantitative","code_information":[ { "code": "82955", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glutamyltransferase, gamma","code_information":[ { "code": "82977", "type": "APC" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Glycated protein","code_information":[ { "code": "82985", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gold Probe 350 cm Electrical Connector","code_information":[ { "code": "270001241", "type": "APC" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin, chorionic (hCG); quantitative","code_information":[ { "code": "84702", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin, chorionic; Qualitative","code_information":[ { "code": "84703", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin; follicle stimulating hormone (FSH)","code_information":[ { "code": "83001", "type": "APC" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin; luteinizing hormone (LH)","code_information":[ { "code": "83002", "type": "APC" } ],"standard_charges":[{"minimum":30.5500,"maximum":30.5500,"gross_charge":30.5500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"}]}]},{"description":"Gore Acuaseal Cardiovascular Patch","code_information":[ { "code": "2720027", "type": "APC" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Gore Acuseal Cardiovascular Patch","code_information":[ { "code": "2720930", "type": "APC" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"}]}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "3021048", "type": "APC" } ],"standard_charges":[{"minimum":634.2000,"maximum":634.2000,"gross_charge":634.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"}]}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "8017780", "type": "APC" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":634.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"}]}]},{"description":"Gore Dualmesh Biomaterial 26.0 cm x","code_information":[ { "code": "2710811", "type": "APC" } ],"standard_charges":[{"minimum":2433.2000,"maximum":2433.2000,"gross_charge":2433.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"}]}]},{"description":"GORE EXCLUDER AAA Endoprosthesis","code_information":[ { "code": "3019130", "type": "APC" } ],"standard_charges":[{"minimum":11603.2000,"maximum":11603.2000,"gross_charge":11603.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"}]}]},{"description":"GORE Excluder Conformable AAA","code_information":[ { "code": "3021206", "type": "APC" } ],"standard_charges":[{"minimum":14074.2000,"maximum":14074.2000,"gross_charge":14074.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"}]}]},{"description":"GORE PRECLUDE Pericardial Membrane","code_information":[ { "code": "2700226", "type": "APC" } ],"standard_charges":[{"minimum":462.0000,"maximum":462.0000,"gross_charge":462.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"}]}]},{"description":"GORE PROPATEN Vascular Graft","code_information":[ { "code": "2750234", "type": "APC" } ],"standard_charges":[{"minimum":1939.0000,"maximum":1939.0000,"gross_charge":1939.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX CV-3","code_information":[ { "code": "270001245", "type": "APC" } ],"standard_charges":[{"minimum":947.8000,"maximum":947.8000,"gross_charge":947.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"}]}]},{"description":"Gore-Tex Stretch Vascular Graft 6 mm x","code_information":[ { "code": "2710897", "type": "APC" } ],"standard_charges":[{"minimum":1050.0000,"maximum":1050.0000,"gross_charge":1050.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX Suture CV-5","code_information":[ { "code": "270001247", "type": "APC" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX Suture CV-6","code_information":[ { "code": "270001249", "type": "APC" } ],"standard_charges":[{"minimum":33.9100,"maximum":33.9100,"gross_charge":33.9100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"}]}]},{"description":"GOR-TEX CV-4 Suture","code_information":[ { "code": "270001243", "type": "APC" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"}]}]},{"description":"Graft Sizers Size 05 mm- 24 mm","code_information":[ { "code": "270001251", "type": "APC" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Graft Sizers Size 24 mm- 38 mm","code_information":[ { "code": "270000533", "type": "APC" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Growth Hormone, human (HGH)","code_information":[ { "code": "83003", "type": "APC" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"}]}]},{"description":"Guidewire GWBC30 Confida 29L 3YSL","code_information":[ { "code": "3017622", "type": "APC" } ],"standard_charges":[{"minimum":218.4000,"maximum":218.4000,"gross_charge":218.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"}]}]},{"description":"Guiding Catheter 6F XB 3.5 100cm","code_information":[ { "code": "270000535", "type": "APC" } ],"standard_charges":[{"minimum":147.0000,"maximum":147.0000,"gross_charge":147.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"}]}]},{"description":"GW N141802 NITREX V03","code_information":[ { "code": "270000685", "type": "APC" } ],"standard_charges":[{"minimum":105.0000,"maximum":105.0000,"gross_charge":105.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"}]}]},{"description":"Haemophilus Influenza","code_information":[ { "code": "86684", "type": "APC" } ],"standard_charges":[{"minimum":245.1400,"maximum":245.1400,"gross_charge":245.1400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"}]}]},{"description":"Harmonic 1100 Shears Integrated Hand","code_information":[ { "code": "270000539", "type": "APC" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"}]}]},{"description":"Harmonic Blue Hand Piece and Blue Test","code_information":[ { "code": "270000541", "type": "APC" } ],"standard_charges":[{"minimum":27328.0000,"maximum":27328.0000,"gross_charge":27328.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"}]}]},{"description":"Harmonic Focus Shears + Adaptative","code_information":[ { "code": "270001253", "type": "APC" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Harmonic HD 1000i Shears Integrated","code_information":[ { "code": "270000543", "type": "APC" } ],"standard_charges":[{"minimum":774.2000,"maximum":774.2000,"gross_charge":774.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"}]}]},{"description":"Harmony Delivery Catheter System 25 Fr","code_information":[ { "code": "3020666", "type": "APC" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Heart transplant, with or without recipient cardiectomy","code_information":[ { "code": "33945", "type": "APC" } ],"standard_charges":[{"minimum":6535.4200,"maximum":6535.4200,"gross_charge":6535.4200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"}]}]},{"description":"Heavy Metals; qualitative, any number of analytes","code_information":[ { "code": "83015", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Helicobacter Pylori","code_information":[ { "code": "86677", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori stool","code_information":[ { "code": "87338", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope","code_information":[ { "code": "83013", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hema-Carotid Vascular Patch Ultrathin","code_information":[ { "code": "2700854", "type": "APC" } ],"standard_charges":[{"minimum":112.0000,"maximum":112.0000,"gross_charge":112.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"}]}]},{"description":"Hemashield Woven Double Velour","code_information":[ { "code": "2700908", "type": "APC" } ],"standard_charges":[{"minimum":996.1000,"maximum":996.1000,"gross_charge":996.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"}]}]},{"description":"Hemashield Knitted Double 2_x001D_ X 6\"","code_information":[ { "code": "2710995", "type": "APC" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":868.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoconcentrator Perfusion Service","code_information":[ { "code": "2740020", "type": "APC" } ],"standard_charges":[{"minimum":126.0000,"maximum":126.0000,"gross_charge":126.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin Fractionation and quantitation; electrophoresis","code_information":[ { "code": "83020", "type": "APC" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin S, per test","code_information":[ { "code": "83021", "type": "APC" } ],"standard_charges":[{"minimum":62.5000,"maximum":62.5000,"gross_charge":62.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; glycosilated (A1C)","code_information":[ { "code": "83036", "type": "APC" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; Methemoglobin, quantitative","code_information":[ { "code": "83050", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinin; auto, screen, each","code_information":[ { "code": "86940", "type": "APC" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinins; Incubated","code_information":[ { "code": "86941", "type": "APC" } ],"standard_charges":[{"minimum":89.5000,"maximum":89.5000,"gross_charge":89.5000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Heparin assay","code_information":[ { "code": "85520", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatic function panel","code_information":[ { "code": "80076", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A Antibody","code_information":[ { "code": "86708", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A Antibody IgM antibody","code_information":[ { "code": "86709", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Core Antibody Total","code_information":[ { "code": "86704", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Surface antigen","code_information":[ { "code": "87340", "type": "APC" } ],"standard_charges":[{"minimum":50.4000,"maximum":50.4000,"gross_charge":50.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Surface Antigen neutralization","code_information":[ { "code": "87341", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Virus, quantification","code_information":[ { "code": "87517", "type": "APC" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis BE Antibody","code_information":[ { "code": "86707", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis BE Antigen","code_information":[ { "code": "87350", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C Antibody","code_information":[ { "code": "86803", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C Quantification, includes reverse transcription when performed","code_information":[ { "code": "87522", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C virus","code_information":[ { "code": "87902", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis Delta agent","code_information":[ { "code": "86692", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Herpes Simplex Virus; amplified probe technique","code_information":[ { "code": "87529", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"}]}]},{"description":"Herpes Simplex, non-specific type test","code_information":[ { "code": "86694", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Heterophile antibodies; screening","code_information":[ { "code": "86308", "type": "APC" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":7.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"}]}]},{"description":"Hex Wrench Model","code_information":[ { "code": "270000545", "type": "APC" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"}]}]},{"description":"Histoplasma","code_information":[ { "code": "86698", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Histoplasma capsulatum","code_information":[ { "code": "87385", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hi-Torque Whisper MS Guide Wire","code_information":[ { "code": "270000547", "type": "APC" } ],"standard_charges":[{"minimum":126.3500,"maximum":126.3500,"gross_charge":126.3500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"}]}]},{"description":"HIV 1 and 2 Antibody","code_information":[ { "code": "86703", "type": "APC" } ],"standard_charges":[{"minimum":5.8200,"maximum":5.8200,"gross_charge":5.8200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"}]}]},{"description":"HIV 1 Antibody","code_information":[ { "code": "86701", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1 antigens, with HIV-1 and HIV2 Antibodies, single result","code_information":[ { "code": "87389", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1, quantification, includes reverse transcription when performed","code_information":[ { "code": "87536", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 13","code_information":[ { "code": "87390", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV-1, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87535", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV-1, reverse transcriptase and protease regions","code_information":[ { "code": "87901", "type": "APC" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, low resolution assessment, HLA-A, -B, -C, -DRB1\/3\/4\/5, and -DQB10","code_information":[ { "code": "81370", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HLA Class I tiping, high resolution, complete, one allele or allele group, each","code_information":[ { "code": "81381", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HLA typing; A, B or C, single antigen","code_information":[ { "code": "86812", "type": "APC" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"}]}]},{"description":"Homocysteine","code_information":[ { "code": "83090", "type": "APC" } ],"standard_charges":[{"minimum":203.0000,"maximum":203.0000,"gross_charge":203.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"}]}]},{"description":"HTLV I","code_information":[ { "code": "86687", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HTLV or HIV antibody, confirmatory test","code_information":[ { "code": "86689", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HTT gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81271", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Human Papillomavirus, High Risk types","code_information":[ { "code": "87624", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Human to human leukocyte antigens (HLA), solid phase assays; antibody identification by qualitative panel using complete HLA phenotypes, HLA class I","code_information":[ { "code": "86830", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydrophilic Coated Spring Coil Guide","code_information":[ { "code": "270000551", "type": "APC" } ],"standard_charges":[{"minimum":187.6000,"maximum":187.6000,"gross_charge":187.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"}]}]},{"description":"Hydrophilic Guidewire 0.035in x 180cm","code_information":[ { "code": "270000553", "type": "APC" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxycorticosteroids, 17-","code_information":[ { "code": "83491", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxyindolacetic acid, 5-","code_information":[ { "code": "83497", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxyprogesterone, 17-d","code_information":[ { "code": "83498", "type": "APC" } ],"standard_charges":[{"minimum":260.6200,"maximum":260.6200,"gross_charge":260.6200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"}]}]},{"description":"Hysteroscopy, surgical; with endometrial ablation","code_information":[ { "code": "58563", "type": "APC" } ],"standard_charges":[{"minimum":342.5900,"maximum":342.5900,"gross_charge":342.5900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"}]}]},{"description":"ICD Fortify DR","code_information":[ { "code": "2820146", "type": "APC" } ],"standard_charges":[{"minimum":18998.0000,"maximum":18998.0000,"gross_charge":18998.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"}]}]},{"description":"ICD-VR DVFC3D1 Visia AF MRI S US DF1","code_information":[ { "code": "3017510", "type": "APC" } ],"standard_charges":[{"minimum":11175.0000,"maximum":11175.0000,"gross_charge":11175.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"}]}]},{"description":"IGA Testing","code_information":[ { "code": "NRL40", "type": "APC" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method","code_information":[ { "code": "83516", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative, by radioimmunoassay","code_information":[ { "code": "83519", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","code_information":[ { "code": "83520", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunofixation electrophoresis; serum","code_information":[ { "code": "86334", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoglobulin E (IgE)","code_information":[ { "code": "82785", "type": "APC" } ],"standard_charges":[{"minimum":12.6000,"maximum":12.6000,"gross_charge":12.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage Forearm and\/or wrist - bursa","code_information":[ { "code": "25031", "type": "APC" } ],"standard_charges":[{"minimum":530.2200,"maximum":530.2200,"gross_charge":530.2200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage leg or ankle deep abcess or hematoma","code_information":[ { "code": "27603", "type": "APC" } ],"standard_charges":[{"minimum":551.8800,"maximum":551.8800,"gross_charge":551.8800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage of an upper arm or elbow area; deep abscess or hematoma","code_information":[ { "code": "23930", "type": "APC" } ],"standard_charges":[{"minimum":304.7400,"maximum":304.7400,"gross_charge":304.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage of Hematoma, seroma or fluid collection","code_information":[ { "code": "10140", "type": "APC" } ],"standard_charges":[{"minimum":164.0500,"maximum":164.0500,"gross_charge":164.0500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage, bursa, foot","code_information":[ { "code": "28001", "type": "APC" } ],"standard_charges":[{"minimum":195.4300,"maximum":195.4300,"gross_charge":195.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of abcess; complicated or multiple","code_information":[ { "code": "10061", "type": "APC" } ],"standard_charges":[{"minimum":259.7600,"maximum":259.7600,"gross_charge":259.7600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of abcess; simple or single","code_information":[ { "code": "10060", "type": "APC" } ],"standard_charges":[{"minimum":148.1100,"maximum":148.1100,"gross_charge":148.1100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, complex, postoperative wound infection","code_information":[ { "code": "10180", "type": "APC" } ],"standard_charges":[{"minimum":251.6100,"maximum":251.6100,"gross_charge":251.6100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, deep abcess or hematoma, soft tissues of neck or thorax","code_information":[ { "code": "21501", "type": "APC" } ],"standard_charges":[{"minimum":478.7700,"maximum":478.7700,"gross_charge":478.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"}]}]},{"description":"Incision and removal of foreing body, subcutaneous tissues; simple","code_information":[ { "code": "10120", "type": "APC" } ],"standard_charges":[{"minimum":146.6900,"maximum":146.6900,"gross_charge":146.6900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antiguen detection by immunofluorescent technique; adnovirus","code_information":[ { "code": "87260", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infectiuos agent detection by nuleic acid DNA PCR not otherwise specified; amipified probe technique, each organism","code_information":[ { "code": "87798", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infectiuos agent detection by nuleic acid DNA PCR not otherwise specified; quantification, each organism","code_information":[ { "code": "87799", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infectius agent antigen detention by immunoassay with direct optical observation; not otherwise specified","code_information":[ { "code": "87899", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infecttiuos agent phenotype analysis by nucleic acids, with drug resistance tissue culture analysis, HIV-1; first through 10 drugs tested","code_information":[ { "code": "87903", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Angiographic Catheter (PIG)","code_information":[ { "code": "270000557", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter (PIG)","code_information":[ { "code": "270000559", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter (PIG)","code_information":[ { "code": "270000561", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter JR-4","code_information":[ { "code": "270000563", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITY Diagstic Catheter JR-4","code_information":[ { "code": "270000565", "type": "APC" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza","code_information":[ { "code": "87804", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza A and B, each","code_information":[ { "code": "87400", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and mutiplex amplified probe technique, first 2 types or sub types","code_information":[ { "code": "87502", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ingevity + 7841 52CM","code_information":[ { "code": "3017220", "type": "APC" } ],"standard_charges":[{"minimum":819.0000,"maximum":819.0000,"gross_charge":819.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"}]}]},{"description":"Ingevity+ 7840 45CM","code_information":[ { "code": "3020156", "type": "APC" } ],"standard_charges":[{"minimum":805.0000,"maximum":805.0000,"gross_charge":805.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography","code_information":[ { "code": "93567", "type": "APC" } ],"standard_charges":[{"minimum":50.3700,"maximum":50.3700,"gross_charge":50.3700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"}]}]},{"description":"Injection procedure; lymphangiography","code_information":[ { "code": "38790", "type": "APC" } ],"standard_charges":[{"minimum":115.4900,"maximum":115.4900,"gross_charge":115.4900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"}]}]},{"description":"Injection, dipyridamole, per 10 mg","code_information":[ { "code": "J1245", "type": "APC" } ],"standard_charges":[{"minimum":30.8000,"maximum":30.8000,"gross_charge":30.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"}]}]},{"description":"Inpatient Step - Down Unit (For patient in Emergency Room w admission order)","code_information":[ { "code": "160000001", "type": "APC" } ],"standard_charges":[{"minimum":371.4300,"maximum":400.0000,"gross_charge":371.4300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"}]}]},{"description":"Insertion of a cannula for hemodialysis, other purpose (separe procedure); vein-to-vein","code_information":[ { "code": "36800", "type": "APC" } ],"standard_charges":[{"minimum":163.2300,"maximum":163.2300,"gross_charge":163.2300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"}]}]},{"description":"Insertion of a non-tunneled centrally inserted central venous catheter; younger than 5 years of age","code_information":[ { "code": "36556", "type": "APC" } ],"standard_charges":[{"minimum":116.0200,"maximum":116.0200,"gross_charge":116.0200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"}]}]},{"description":"Insertion of a peripherally inserted central venous access device, with subcutaneous port; younger than five years of age","code_information":[ { "code": "36570", "type": "APC" } ],"standard_charges":[{"minimum":464.2100,"maximum":464.2100,"gross_charge":464.2100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"}]}]},{"description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator","code_information":[ { "code": "33216", "type": "APC" } ],"standard_charges":[{"minimum":503.6100,"maximum":503.6100,"gross_charge":503.6100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous access device with a subcutaneous pump","code_information":[ { "code": "36563", "type": "APC" } ],"standard_charges":[{"minimum":499.6900,"maximum":499.6900,"gross_charge":499.6900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous access device, with subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36560", "type": "APC" } ],"standard_charges":[{"minimum":534.4900,"maximum":534.4900,"gross_charge":534.4900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36557", "type": "APC" } ],"standard_charges":[{"minimum":440.1600,"maximum":440.1600,"gross_charge":440.1600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"}]}]},{"description":"Insertion of an intra-aortic balloon assist device, percutaneous","code_information":[ { "code": "33967", "type": "APC" } ],"standard_charges":[{"minimum":346.6300,"maximum":346.6300,"gross_charge":346.6300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"}]}]},{"description":"Insertion of epicardial electrode; endoscopic approach","code_information":[ { "code": "33203", "type": "APC" } ],"standard_charges":[{"minimum":1116.2900,"maximum":1116.2900,"gross_charge":1116.2900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"}]}]},{"description":"Insertion of epicardial electrode; open incision","code_information":[ { "code": "33202", "type": "APC" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of indwelling tunneled pleural catheter with cuff","code_information":[ { "code": "32550", "type": "APC" } ],"standard_charges":[{"minimum":275.1000,"maximum":275.1000,"gross_charge":275.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radilogical supervision and interpretation, intraprocedural roadmapping, and imaging guidance, when perfomed","code_information":[ { "code": "37191", "type": "APC" } ],"standard_charges":[{"minimum":299.1000,"maximum":299.1000,"gross_charge":299.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; atrial and ventricular","code_information":[ { "code": "33208", "type": "APC" } ],"standard_charges":[{"minimum":710.6400,"maximum":710.6400,"gross_charge":710.6400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"}]}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; ventricular","code_information":[ { "code": "33207", "type": "APC" } ],"standard_charges":[{"minimum":645.9000,"maximum":645.9000,"gross_charge":645.9000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacemaker pulse generator only; with existing single lead","code_information":[ { "code": "33212", "type": "APC" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator","code_information":[ { "code": "33225", "type": "APC" } ],"standard_charges":[{"minimum":629.0900,"maximum":629.0900,"gross_charge":629.0900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator","code_information":[ { "code": "33224", "type": "APC" } ],"standard_charges":[{"minimum":698.1200,"maximum":698.1200,"gross_charge":698.1200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of permanent implantable defibrillator system, with transvenous lead, single or dual chamber","code_information":[ { "code": "33249", "type": "APC" } ],"standard_charges":[{"minimum":1230.7800,"maximum":1230.7800,"gross_charge":1230.7800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of temporary transvenous single chaber cardiac electrode or pacemaker catheter","code_information":[ { "code": "33210", "type": "APC" } ],"standard_charges":[{"minimum":219.7700,"maximum":219.7700,"gross_charge":219.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"}]}]},{"description":"Insertion, subcutaneous cardiac rhythm monitor, including programming","code_information":[ { "code": "33285", "type": "APC" } ],"standard_charges":[{"minimum":800.0000,"maximum":800.0000,"gross_charge":800.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"}]}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021080", "type": "APC" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"}]}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021081", "type": "APC" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"}]}]},{"description":"Insulin antibodies","code_information":[ { "code": "86337", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Insulin Level Total","code_information":[ { "code": "83525", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Intensive Care Unit (ICU)","code_information":[ { "code": "201000001", "type": "APC" } ],"standard_charges":[{"minimum":1199.8000,"maximum":782.0000,"gross_charge":1199.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"}]}]},{"description":"Intergard Aortic ARCH #24mm","code_information":[ { "code": "2760101", "type": "APC" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711176", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711178", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711181", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2780000", "type": "APC" } ],"standard_charges":[{"minimum":821.8000,"maximum":821.8000,"gross_charge":821.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #24MM x","code_information":[ { "code": "2711209", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #10mm X","code_information":[ { "code": "2711186", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #22mm X","code_information":[ { "code": "2711197", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #8mm X 40cm","code_information":[ { "code": "2719754", "type": "APC" } ],"standard_charges":[{"minimum":565.6000,"maximum":565.6000,"gross_charge":565.6000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 10 X 30cm Straight","code_information":[ { "code": "2711207", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 26 x 10cm Straight","code_information":[ { "code": "2711213", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 28 X 30cm Straight.","code_information":[ { "code": "2711216", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 30 X 30cm Straight","code_information":[ { "code": "2711226", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2710941", "type": "APC" } ],"standard_charges":[{"minimum":727.3000,"maximum":727.3000,"gross_charge":727.3000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2711218", "type": "APC" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2780608", "type": "APC" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2781619", "type": "APC" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":786.1000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"INTERING VASC GRAFT STR TW IR 6mmX80cm","code_information":[ { "code": "2740135", "type": "APC" } ],"standard_charges":[{"minimum":1659.0000,"maximum":1659.0000,"gross_charge":1659.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"}]}]},{"description":"Interject (Injection Therapy Needle","code_information":[ { "code": "2810766", "type": "APC" } ],"standard_charges":[{"minimum":231.0000,"maximum":231.0000,"gross_charge":231.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"}]}]},{"description":"Interleukin-6 (IL-6)","code_information":[ { "code": "83529", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Intra cardiac catheter ablation of artrioventricular node function, atrion ventricular condution for creation of complete heart block, with or without temporary pacemaker placement","code_information":[ { "code": "93650", "type": "APC" } ],"standard_charges":[{"minimum":791.7400,"maximum":791.7400,"gross_charge":791.7400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"}]}]},{"description":"Intra-Aortic Ballon Tray Ready (IABP","code_information":[ { "code": "2704760", "type": "APC" } ],"standard_charges":[{"minimum":1300.0000,"maximum":1300.0000,"gross_charge":1300.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"}]}]},{"description":"Intra-Aortic Balloon Catheter and","code_information":[ { "code": "2721120", "type": "APC" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"Intra-atrial pacing","code_information":[ { "code": "93610", "type": "APC" } ],"standard_charges":[{"minimum":4712.9300,"maximum":4712.9300,"gross_charge":4712.9300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":4712.9300,"methodology":"fee schedule"}]}]},{"description":"Intracardiac electrophysiology 3 dimensional mapping","code_information":[ { "code": "93613", "type": "APC" } ],"standard_charges":[{"minimum":390.2400,"maximum":390.2400,"gross_charge":390.2400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"}]}]},{"description":"Intravascular ultrasound during diagnostic evaluation and\/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel","code_information":[ { "code": "37253", "type": "APC" } ],"standard_charges":[{"minimum":95.8900,"maximum":95.8900,"gross_charge":95.8900,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"}]}]},{"description":"Intravascular ultrasound during diagnostic evaluation and\/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel","code_information":[ { "code": "37252", "type": "APC" } ],"standard_charges":[{"minimum":120.5500,"maximum":120.5500,"gross_charge":120.5500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"fee schedule"}]}]},{"description":"Intraventricular and\/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify the origin of tachycardia","code_information":[ { "code": "93609", "type": "APC" } ],"standard_charges":[{"minimum":2827.7600,"maximum":2827.7600,"gross_charge":2827.7600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"}]}]},{"description":"INTRO HLS2507MCN Safe Sheath 7 FR 25CM","code_information":[ { "code": "3020167", "type": "APC" } ],"standard_charges":[{"minimum":78.4000,"maximum":78.4000,"gross_charge":78.4000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"}]}]},{"description":"Introduction of needle or intracatheter, upper or lower extremity artery","code_information":[ { "code": "36140", "type": "APC" } ],"standard_charges":[{"minimum":121.0200,"maximum":121.0200,"gross_charge":121.0200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"fee schedule"}]}]},{"description":"Introduction of needle(s) and\/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct punture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomisis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and repor","code_information":[ { "code": "36901", "type": "APC" } ],"standard_charges":[{"minimum":228.2600,"maximum":228.2600,"gross_charge":228.2600,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"fee schedule"}]}]},{"description":"Intubating Style Adult","code_information":[ { "code": "2709185", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Iron","code_information":[ { "code": "83540", "type": "APC" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Iron Binding Capacity","code_information":[ { "code": "83550", "type": "APC" } ],"standard_charges":[{"minimum":18.0000,"maximum":18.0000,"gross_charge":18.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"}]}]},{"description":"Irradiation of blood product, each unit","code_information":[ { "code": "86945", "type": "APC" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"}]}]},{"description":"IS-1 (3.2mm) Receptacle Plug","code_information":[ { "code": "270000573", "type": "APC" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"}]}]},{"description":"IS4\/DF4 Connector Sleeve","code_information":[ { "code": "270000575", "type": "APC" } ],"standard_charges":[{"minimum":9139.2000,"maximum":9139.2000,"gross_charge":9139.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"}]}]},{"description":"IS4\/DF4 Plug","code_information":[ { "code": "2730053", "type": "APC" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"Islet cell antibody","code_information":[ { "code": "86341", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"ISOFLEX Pacing lead","code_information":[ { "code": "2820699", "type": "APC" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"}]}]},{"description":"Isolation","code_information":[ { "code": "164000005", "type": "APC" } ],"standard_charges":[{"minimum":410.0000,"maximum":410.0000,"gross_charge":410.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"}]}]},{"description":"John Cunningham virus Antibody","code_information":[ { "code": "86711", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Jot Dx Insertable Cardiac Monitor","code_information":[ { "code": "2750479", "type": "APC" } ],"standard_charges":[{"minimum":3500.0000,"maximum":3500.0000,"gross_charge":3500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"}]}]},{"description":"Ketones body(s); qualitative","code_information":[ { "code": "82009", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ketones body(s); quantitative","code_information":[ { "code": "82010", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"}]}]},{"description":"Ketosteroids, 17- (17-KS); total","code_information":[ { "code": "83586", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Konect Resilia Aortic Valved Conduit","code_information":[ { "code": "3020098", "type": "APC" } ],"standard_charges":[{"minimum":15540.0000,"maximum":15540.0000,"gross_charge":15540.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"}]}]},{"description":"Lactate","code_information":[ { "code": "83605", "type": "APC" } ],"standard_charges":[{"minimum":76.0000,"maximum":76.0000,"gross_charge":76.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"}]}]},{"description":"Lactate Dehydrogenase (LD), (LDH)","code_information":[ { "code": "83615", "type": "APC" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee 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schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":2586.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":2586.6000,"methodology":"fee schedule"}]}]},{"description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass","code_information":[ { "code": "33425", "type": "APC" } ],"standard_charges":[{"minimum":3673.8700,"maximum":3673.8700,"gross_charge":3673.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":3673.8700,"methodology":"fee schedule"}]}]},{"description":"Valvuloplasty, tricuspid valve; with ring insertion","code_information":[ { "code": "33464", "type": "APC" } ],"standard_charges":[{"minimum":3280.3800,"maximum":3280.3800,"gross_charge":3280.3800,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"}]}]},{"description":"Valvuloplasty, tricuspid valve; without ring insertion","code_information":[ { "code": "33463", "type": "APC" } ],"standard_charges":[{"minimum":4134.6500,"maximum":4134.6500,"gross_charge":4134.6500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"}]}]},{"description":"Vancomycin","code_information":[ { "code": "80202", "type": "APC" } ],"standard_charges":[{"minimum":61.0000,"maximum":61.0000,"gross_charge":61.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"}]}]},{"description":"Vanillymandelic acid urine","code_information":[ { "code": "84585", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Varicella zoster","code_information":[ { "code": "86787", "type": "APC" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"}]}]},{"description":"Varicella Zoster Direct FA","code_information":[ { "code": "87290", "type": "APC" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular Access System (ELLIPSYS)","code_information":[ { "code": "270001343", "type": "APC" } ],"standard_charges":[{"minimum":7014.0000,"maximum":7014.0000,"gross_charge":7014.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage","code_information":[ { "code": "37241", "type": "APC" } ],"standard_charges":[{"minimum":569.5200,"maximum":569.5200,"gross_charge":569.5200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"}]}]},{"description":"Vascular ProGlide 6Fr.(2.oomm)","code_information":[ { "code": "3020151", "type": "APC" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular Stent System SFA and ILIAC","code_information":[ { "code": "4801039", "type": "APC" } ],"standard_charges":[{"minimum":500.0000,"maximum":500.0000,"gross_charge":500.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"}]}]},{"description":"Vegram Ballon Catheter Attain","code_information":[ { "code": "270000087", "type": "APC" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Vegram Balloon Catheter","code_information":[ { "code": "270001061", "type": "APC" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"Vein Pick (Model 6541)","code_information":[ { "code": "270001059", "type": "APC" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"VenaSeal Closure System","code_information":[ { "code": "270001345", "type": "APC" } ],"standard_charges":[{"minimum":1680.0000,"maximum":1680.0000,"gross_charge":1680.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"}]}]},{"description":"Venipuncture, cuntdown; age 1 or over","code_information":[ { "code": "36425", "type": "APC" } ],"standard_charges":[{"minimum":53.6300,"maximum":53.6300,"gross_charge":53.6300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"}]}]},{"description":"Venography- caval, inferior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75825", "type": "APC" } ],"standard_charges":[{"minimum":157.3300,"maximum":157.3300,"gross_charge":157.3300,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"}]}]},{"description":"Venography- caval, superior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75827", "type": "APC" } ],"standard_charges":[{"minimum":163.8100,"maximum":163.8100,"gross_charge":163.8100,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"}]}]},{"description":"Venography-Adrenal,Bilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75842", "type": "APC" } ],"standard_charges":[{"minimum":219.1400,"maximum":219.1400,"gross_charge":219.1400,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"fee schedule"}]}]},{"description":"Venography-Adrenal,Unilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75840", "type": "APC" } ],"standard_charges":[{"minimum":177.2700,"maximum":177.2700,"gross_charge":177.2700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"fee schedule"}]}]},{"description":"Venography-Extremity, Bilateral, radiological supervision and interpretation","code_information":[ { "code": "75822", "type": "APC" } ],"standard_charges":[{"minimum":184.0200,"maximum":184.0200,"gross_charge":184.0200,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"fee schedule"}]}]},{"description":"Venography-Extremity, Unilateral, radiological supervision and interpretation","code_information":[ { "code": "75820", "type": "APC" } ],"standard_charges":[{"minimum":148.6700,"maximum":148.6700,"gross_charge":148.6700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"fee schedule"}]}]},{"description":"Venography-Renal, Bilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75833", "type": "APC" } ],"standard_charges":[{"minimum":204.2500,"maximum":204.2500,"gross_charge":204.2500,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"fee schedule"}]}]},{"description":"Venography-Renal, Unilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75831", "type": "APC" } ],"standard_charges":[{"minimum":164.7700,"maximum":164.7700,"gross_charge":164.7700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"fee schedule"}]}]},{"description":"Venous sampling through catheter, with or without angiography, radiological supervision and interpretation","code_information":[ { "code": "75893", "type": "APC" } ],"standard_charges":[{"minimum":145.1700,"maximum":145.1700,"gross_charge":145.1700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"fee schedule"}]}]},{"description":"VersaCross Connect LAAC Access","code_information":[ { "code": "3021220", "type": "APC" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"}]}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021166", "type": "APC" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021167", "type": "APC" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":560.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Vesseal Sealer Extend","code_information":[ { "code": "3021112", "type": "APC" } ],"standard_charges":[{"minimum":918.8700,"maximum":918.8700,"gross_charge":918.8700,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"}]}]},{"description":"Veus Cannula 32\/40 Fr","code_information":[ { "code": "2702630", "type": "APC" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Veus Cannula Pediatric","code_information":[ { "code": "2702625", "type": "APC" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"VIABAHN BX BALLOON EXP ENDO 8mmX59mm","code_information":[ { "code": "3021051", "type": "APC" } ],"standard_charges":[{"minimum":5653.2000,"maximum":5653.2000,"gross_charge":5653.2000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"}]}]},{"description":"VIABAHN SX ENDO 35 RO 5mmX5cm 7Fr","code_information":[ { "code": "3020841", "type": "APC" } ],"standard_charges":[{"minimum":3544.8000,"maximum":3544.8000,"gross_charge":3544.8000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee 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],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Tricare","plan_name":"Tricare","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Smear, primary source with interpretation; fluorescent and\/or acid fast stain for bacteria, fungi parasites, viruses or cell types","code_information":[ { "code": "87206", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":7.9900,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee 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separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"}]}]},{"description":"IgM antibody","code_information":[ { "code": "86705", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First 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separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"}]}]},{"description":"MR Cardiac magnetic resonance imaging for morphology and funtion without contrast material","code_information":[ { "code": "75557", "type": "CPT" } ],"standard_charges":[{"minimum":401.7400,"maximum":401.7400,"gross_charge":401.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.7400,"methodology":"fee schedule"}]}]},{"description":"Partial esophagectomy, distal two-thirds, with thoracotomy only, with or woithout proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty","code_information":[ { "code": "43121", "type": "CPT" } ],"standard_charges":[{"minimum":3864.5700,"maximum":3864.5700,"gross_charge":3864.5700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First 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schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3864.5700,"methodology":"fee schedule"}]}]},{"description":"Penile vascular study complete","code_information":[ { "code": "93980", "type": "CPT" } ],"standard_charges":[{"minimum":152.0000,"maximum":175.5000,"gross_charge":152.0000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.0000,"methodology":"per diem"}]}]},{"description":"Repair of a hypoplastic or interrupted aortic arch using autogenous or prosthetic material; without cardiopulmonary bypass","code_information":[ { "code": "33852", "type": "CPT" } ],"standard_charges":[{"minimum":1897.7700,"maximum":1897.7700,"gross_charge":1897.7700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1378.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed 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schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular study duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study","code_information":[ { "code": "93979", "type": "CPT" } ],"standard_charges":[{"minimum":153.2400,"maximum":73.1300,"gross_charge":153.2400,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"fee schedule"}]}]},{"description":"Vascular study - duplex scan of arterial inflow and venous outflow of abdomen, retroperitoneum, scrotal contents and\/or pelvic organs.","code_information":[ { "code": "93975", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":175.5000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":265.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular study - Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and\/or retroperitoneal organs.","code_information":[ { "code": "93976", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":105.3000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular study - Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and\/or retroperitoneal organs.","code_information":[ { "code": "93978", "type": "CPT" } ],"standard_charges":[{"minimum":153.2400,"maximum":122.8500,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"per diem"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"fee schedule"}]}]},{"description":"1 25 Dihydroxy Vitamin D","code_information":[ { "code": "82306", "type": "CPT" } ],"standard_charges":[{"minimum":144.2000,"maximum":44.0400,"gross_charge":144.2000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":144.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"3 Hydroxybutyric Acid","code_information":[ { "code": "82010", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":10.1100,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"}]}]},{"description":"3D Mapping - Intracardiac Electrophysiological Procedures\/Studies","code_information":[ { "code": "93609", "type": "CPT" } ],"standard_charges":[{"minimum":2827.7600,"maximum":6180.0000,"gross_charge":2827.7600,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"fee schedule"}]}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","code_information":[ { "code": "76376", "type": "CPT" } ],"standard_charges":[{"minimum":34.3300,"maximum":34.3300,"gross_charge":34.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"fee schedule"}]}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","code_information":[ { "code": "76377", "type": "CPT" } ],"standard_charges":[{"minimum":108.1900,"maximum":108.1900,"gross_charge":108.1900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"fee schedule"}]}]},{"description":"Abdominal paracentesis, with imaging guidance","code_information":[ { "code": "49083", "type": "CPT" } ],"standard_charges":[{"minimum":1080.0000,"maximum":1080.0000,"gross_charge":1080.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal paracentesis, without imaging guidance","code_information":[ { "code": "49082", "type": "CPT" } ],"standard_charges":[{"minimum":1080.0000,"maximum":1080.0000,"gross_charge":1080.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ablation for Atrial Fibrilation","code_information":[ { "code": "93656", "type": "CPT" } ],"standard_charges":[{"minimum":1268.3600,"maximum":6180.0000,"gross_charge":1268.3600,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":1268.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":1268.3600,"methodology":"fee schedule"}]}]},{"description":"Ablation for Atrial Flutter","code_information":[ { "code": "93653", "type": "CPT" } ],"standard_charges":[{"minimum":1118.5600,"maximum":6180.0000,"gross_charge":1118.5600,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"fee schedule"}]}]},{"description":"Ablation for Vent Thachycardia","code_information":[ { "code": "93654", "type": "CPT" } ],"standard_charges":[{"minimum":1347.5800,"maximum":12875.0000,"gross_charge":1347.5800,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"fee schedule"}]}]},{"description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor incluiding pleural or chest wall ehen involved by rumor extension, percutaneous, incluiding imaging guidance when performed, unilateral; Cryoablation","code_information":[ { "code": "32994", "type": "CPT" } ],"standard_charges":[{"minimum":595.2100,"maximum":595.2100,"gross_charge":595.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"fee schedule"}]}]},{"description":"ABO\/RH (Gel)","code_information":[ { "code": "86901", "type": "CPT" } ],"standard_charges":[{"minimum":63.0000,"maximum":6.8100,"gross_charge":63.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acetaminophen","code_information":[ { "code": "80143", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Acetylcholine Receptor; binding antibody","code_information":[ { "code": "86041", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Actin, antibody (ASMA), each","code_information":[ { "code": "86015", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Acute Hepatitis Panel","code_information":[ { "code": "80074", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Acylcarnitines; qualitative, each specimen","code_information":[ { "code": "82016", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Adrenalectomy, partial or complete; with excision of adjacent retroperitoneal tumor","code_information":[ { "code": "60545", "type": "CPT" } ],"standard_charges":[{"minimum":1719.4200,"maximum":1719.4200,"gross_charge":1719.4200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"fee schedule"}]}]},{"description":"Adrenalectomy, partial or complete; with out radical mediastinal dissection","code_information":[ { "code": "60521", "type": "CPT" } ],"standard_charges":[{"minimum":1531.7800,"maximum":1531.7800,"gross_charge":1531.7800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"fee schedule"}]}]},{"description":"Adrenocorticotropic Hormone","code_information":[ { "code": "82024", "type": "CPT" } ],"standard_charges":[{"minimum":72.1000,"maximum":72.1000,"gross_charge":72.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"fee schedule"}]}]},{"description":"Aerosol Daily - Pulmonary Diagnostic Testing and Therapies","code_information":[ { "code": "94642", "type": "CPT" } ],"standard_charges":[{"minimum":34.4100,"maximum":34.4100,"gross_charge":34.4100,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.4100,"methodology":"fee schedule"}]}]},{"description":"Albumin 24 Hour Urine","code_information":[ { "code": "82043", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":8.6000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Albumin Level","code_information":[ { "code": "82040", "type": "CPT" } ],"standard_charges":[{"minimum":21.0000,"maximum":7.3600,"gross_charge":21.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Albumin; other source, quantitative, each specimen","code_information":[ { "code": "82042", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alcohol; breath","code_information":[ { "code": "82075", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alcohols","code_information":[ { "code": "80320", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Aldosterone","code_information":[ { "code": "82088", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alkaloids, not otherwise specified","code_information":[ { "code": "80323", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Allergen Specific IgE; quantitative or semi quantitative, crude allergen extract, each","code_information":[ { "code": "86003", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alpha 1 Antitrypsin Stool","code_information":[ { "code": "82103", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":19.9800,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Alpha Fetoprotein (AFP); serum","code_information":[ { "code": "82105", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Aluminum","code_information":[ { "code": "82108", "type": "CPT" } ],"standard_charges":[{"minimum":87.3600,"maximum":87.3600,"gross_charge":87.3600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"fee schedule"}]}]},{"description":"Amikacin Peak","code_information":[ { "code": "80150", "type": "CPT" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Amino acids, 6 or more amino acids, quantitative, each specimen","code_information":[ { "code": "82139", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Aminoohylline 250mg Vial","code_information":[ { "code": "87070", "type": "CPT" } ],"standard_charges":[{"minimum":18.5800,"maximum":12.8100,"gross_charge":18.5800,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 250MG VIAL","code_information":[ { "code": "J0280", "type": "CPT" } ],"standard_charges":[{"minimum":18.5800,"maximum":18.5800,"gross_charge":18.5800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"}]}]},{"description":"Ammonia","code_information":[ { "code": "82140", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Amphetamine","code_information":[ { "code": "80324", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Amputation Foot; midtarsal","code_information":[ { "code": "28800", "type": "CPT" } ],"standard_charges":[{"minimum":729.1100,"maximum":729.1100,"gross_charge":729.1100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"fee schedule"}]}]},{"description":"Amputation metatarsal with toe single","code_information":[ { "code": "28810", "type": "CPT" } ],"standard_charges":[{"minimum":584.8500,"maximum":584.8500,"gross_charge":584.8500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"fee schedule"}]}]},{"description":"Amputation, forearm, through radius and ulna","code_information":[ { "code": "25900", "type": "CPT" } ],"standard_charges":[{"minimum":1002.4700,"maximum":1002.4700,"gross_charge":1002.4700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"fee schedule"}]}]},{"description":"Amputation, leg, through tibia and fibula","code_information":[ { "code": "27880", "type": "CPT" } ],"standard_charges":[{"minimum":1229.8900,"maximum":1229.8900,"gross_charge":1229.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"fee schedule"}]}]},{"description":"Amputation, thigh, through femur, any level","code_information":[ { "code": "27590", "type": "CPT" } ],"standard_charges":[{"minimum":1073.9800,"maximum":1073.9800,"gross_charge":1073.9800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"fee schedule"}]}]},{"description":"Amylase","code_information":[ { "code": "82150", "type": "CPT" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"}]}]},{"description":"Anaerobic Culture","code_information":[ { "code": "87040", "type": "CPT" } ],"standard_charges":[{"minimum":11.2000,"maximum":15.3500,"gross_charge":11.2000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Androstenedione","code_information":[ { "code": "82157", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Angiography Adrenal bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75733", "type": "CPT" } ],"standard_charges":[{"minimum":238.1500,"maximum":238.1500,"gross_charge":238.1500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"fee schedule"}]}]},{"description":"Angiography Adrenal unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75731", "type": "CPT" } ],"standard_charges":[{"minimum":211.8800,"maximum":211.8800,"gross_charge":211.8800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"fee schedule"}]}]},{"description":"Angiography Extremity Bilateral radiological supervision and interpretation","code_information":[ { "code": "75716", "type": "CPT" } ],"standard_charges":[{"minimum":224.3800,"maximum":224.3800,"gross_charge":224.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"fee schedule"}]}]},{"description":"Angiography Extremity. Unilateral radiological supervision and interpretation","code_information":[ { "code": "75710", "type": "CPT" } ],"standard_charges":[{"minimum":206.8800,"maximum":206.8800,"gross_charge":206.8800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"fee schedule"}]}]},{"description":"Angiography pelvic, selective or supraselective, radiological supervision and interpretation","code_information":[ { "code": "75736", "type": "CPT" } ],"standard_charges":[{"minimum":198.0000,"maximum":198.0000,"gross_charge":198.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"fee schedule"}]}]},{"description":"Angiography spinal selective radiological supervision and interpretation","code_information":[ { "code": "75705", "type": "CPT" } ],"standard_charges":[{"minimum":345.4500,"maximum":345.4500,"gross_charge":345.4500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"fee schedule"}]}]},{"description":"Angiography visceral, selective or suoraselective, radiological supervision and interpretation","code_information":[ { "code": "75726", "type": "CPT" } ],"standard_charges":[{"minimum":234.1200,"maximum":234.1200,"gross_charge":234.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75743", "type": "CPT" } ],"standard_charges":[{"minimum":203.3500,"maximum":203.3500,"gross_charge":203.3500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, by nonselective catheter or venous injection radiological supervision and interpretation","code_information":[ { "code": "75746", "type": "CPT" } ],"standard_charges":[{"minimum":186.0300,"maximum":186.0300,"gross_charge":186.0300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"fee schedule"}]}]},{"description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75741", "type": "CPT" } ],"standard_charges":[{"minimum":179.0300,"maximum":179.0300,"gross_charge":179.0300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"fee schedule"}]}]},{"description":"Angiotensin Converting Enzyme","code_information":[ { "code": "82164", "type": "CPT" } ],"standard_charges":[{"minimum":124.6000,"maximum":21.7100,"gross_charge":124.6000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"fee schedule"}]}]},{"description":"Anti Mitochondrial Antibody","code_information":[ { "code": "86255", "type": "CPT" } ],"standard_charges":[{"minimum":103.8400,"maximum":17.9200,"gross_charge":103.8400,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Anti Phospholipid Antibody","code_information":[ { "code": "86148", "type": "CPT" } ],"standard_charges":[{"minimum":331.8000,"maximum":331.8000,"gross_charge":331.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"fee schedule"}]}]},{"description":"Anti Smith Antibody","code_information":[ { "code": "86235", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":26.6700,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody elution (RBC) each","code_information":[ { "code": "86860", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody identification, RBC antibodies, each panel for each serum technique","code_information":[ { "code": "86870", "type": "CPT" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody screen, RBC, each serum technique","code_information":[ { "code": "86850", "type": "CPT" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"Antibody; Influenza Virus","code_information":[ { "code": "86710", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antidepressants, tricyclic and other cyclicals; 6 or more","code_information":[ { "code": "80337", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antigen testing of donor blood using reagent serum, each antigen test","code_information":[ { "code": "86902", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test (Coombs test); direct, each antiserum","code_information":[ { "code": "86880", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test; Indirect, each antibody titer","code_information":[ { "code": "86886", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test; Indirect, qualitative, each reagent","code_information":[ { "code": "86885", "type": "CPT" } ],"standard_charges":[{"minimum":17.5000,"maximum":17.5000,"gross_charge":17.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNeutrophil Cytoplasmic Antibody; screen each antibody","code_information":[ { "code": "86036", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNuclear Antibodies Titer","code_information":[ { "code": "86039", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"AntiNuclear Antibodies;","code_information":[ { "code": "86038", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin O Screen","code_information":[ { "code": "86063", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin O Titer","code_information":[ { "code": "86060", "type": "CPT" } ],"standard_charges":[{"minimum":10.0100,"maximum":10.0100,"gross_charge":10.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"fee schedule"}]}]},{"description":"Aortography Abdominal by Serialography radiological supervision and interpretation","code_information":[ { "code": "75625", "type": "CPT" } ],"standard_charges":[{"minimum":177.1300,"maximum":177.1300,"gross_charge":177.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"fee schedule"}]}]},{"description":"Aortography abdominal plus bilateral iliofemoral lower extremity, catheter by seriolography, radiological supervision and interpretation","code_information":[ { "code": "75630", "type": "CPT" } ],"standard_charges":[{"minimum":219.6500,"maximum":219.6500,"gross_charge":219.6500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"fee schedule"}]}]},{"description":"Aortography Thoracic by Serialography radiological supervision and interpretation","code_information":[ { "code": "75605", "type": "CPT" } ],"standard_charges":[{"minimum":166.6000,"maximum":166.6000,"gross_charge":166.6000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"}]}]},{"description":"Aortography Thoracic Without Serialography radiological supervision and interpretation","code_information":[ { "code": "75600", "type": "CPT" } ],"standard_charges":[{"minimum":252.2500,"maximum":252.2500,"gross_charge":252.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"fee schedule"}]}]},{"description":"Apolipoprotein E Genotype","code_information":[ { "code": "82172", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":23.0500,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Appendectomy","code_information":[ { "code": "44950", "type": "CPT" } ],"standard_charges":[{"minimum":885.4700,"maximum":885.4700,"gross_charge":885.4700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"fee schedule"}]}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20690", "type": "CPT" } ],"standard_charges":[{"minimum":827.9900,"maximum":827.9900,"gross_charge":827.9900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"fee schedule"}]}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20692", "type": "CPT" } ],"standard_charges":[{"minimum":1591.1400,"maximum":1591.1400,"gross_charge":827.9900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cereb, Unill","code_information":[ { "code": "75665", "type": "CPT" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cerebral, Bil","code_information":[ { "code": "75671", "type": "CPT" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cerv, Unil","code_information":[ { "code": "75676", "type": "CPT" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Carotid,Cervical, Bil","code_information":[ { "code": "75680", "type": "CPT" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arterio-Thoracic Aortogram","code_information":[ { "code": "93567", "type": "CPT" } ],"standard_charges":[{"minimum":50.3700,"maximum":2196.0000,"gross_charge":50.3700,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition","code_information":[ { "code": "36818", "type": "CPT" } ],"standard_charges":[{"minimum":927.7800,"maximum":927.7800,"gross_charge":927.7800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)","code_information":[ { "code": "36821", "type": "CPT" } ],"standard_charges":[{"minimum":887.9200,"maximum":887.9200,"gross_charge":887.9200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"fee schedule"}]}]},{"description":"Arterio-Vertebral, Angio UNI","code_information":[ { "code": "75685", "type": "CPT" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints) surgical; with removal of loose body or foreing body","code_information":[ { "code": "29894", "type": "CPT" } ],"standard_charges":[{"minimum":702.5600,"maximum":702.5600,"gross_charge":702.5600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, hip, diagnostic with or without synovial biopsy","code_information":[ { "code": "29860", "type": "CPT" } ],"standard_charges":[{"minimum":914.6600,"maximum":914.6600,"gross_charge":914.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, diagnostic with or without synovial biopsy","code_information":[ { "code": "29870", "type": "CPT" } ],"standard_charges":[{"minimum":576.0300,"maximum":576.0300,"gross_charge":576.0300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, shoulder, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29805", "type": "CPT" } ],"standard_charges":[{"minimum":654.9900,"maximum":654.9900,"gross_charge":654.9900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29840", "type": "CPT" } ],"standard_charges":[{"minimum":632.6300,"maximum":632.6300,"gross_charge":632.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)","code_information":[ { "code": "33859", "type": "CPT" } ],"standard_charges":[{"minimum":3273.3100,"maximum":3273.3100,"gross_charge":3273.3100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic dissection","code_information":[ { "code": "33858", "type": "CPT" } ],"standard_charges":[{"minimum":4553.1100,"maximum":4553.1100,"gross_charge":4553.1100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, David Procedure, Yacob Procedure)","code_information":[ { "code": "33864", "type": "CPT" } ],"standard_charges":[{"minimum":3273.3100,"maximum":18446.0000,"gross_charge":3273.3100,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduict and coronaru reconstruction (eg, Bentall)","code_information":[ { "code": "33863", "type": "CPT" } ],"standard_charges":[{"minimum":3064.5100,"maximum":18446.0000,"gross_charge":3064.5100,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3064.5100,"methodology":"fee schedule"}]}]},{"description":"Ascending aortic graft, including valve suspension","code_information":[ { "code": "33860", "type": "CPT" } ],"standard_charges":[{"minimum":3273.3100,"maximum":18446.0000,"gross_charge":3273.3100,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"fee schedule"}]}]},{"description":"ASPA gene analysis, common variants","code_information":[ { "code": "81200", "type": "CPT" } ],"standard_charges":[{"minimum":582.4000,"maximum":582.4000,"gross_charge":582.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"fee schedule"}]}]},{"description":"Aspergillus","code_information":[ { "code": "86606", "type": "CPT" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"fee schedule"}]}]},{"description":"Aspiration and injection for treatment of bone cyst","code_information":[ { "code": "20615", "type": "CPT" } ],"standard_charges":[{"minimum":163.4400,"maximum":551.0000,"gross_charge":163.4400,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.4400,"methodology":"fee schedule"}]}]},{"description":"Aspiration and\/or injection of a renal cyst or pelvis by a needle, performed percutaneously","code_information":[ { "code": "50390", "type": "CPT" } ],"standard_charges":[{"minimum":91.8900,"maximum":661.5000,"gross_charge":91.8900,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.8900,"methodology":"fee schedule"}]}]},{"description":"Atherectomy (open or percutaneous) for supra-inguinal arteries","code_information":[ { "code": "0236T", "type": "CPT" } ],"standard_charges":[{"minimum":667.2000,"maximum":6150.0000,"gross_charge":667.2000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"fee schedule"}]}]},{"description":"Atrial septectomy or septostomy \/ inf occlus","code_information":[ { "code": "33736", "type": "CPT" } ],"standard_charges":[{"minimum":1909.8400,"maximum":1342.0000,"gross_charge":1909.8400,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"fee schedule"}]}]},{"description":"Autologous blood or component, collection processing and storage; predeposited","code_information":[ { "code": "86890", "type": "CPT" } ],"standard_charges":[{"minimum":250.0000,"maximum":250.0000,"gross_charge":250.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"per diem"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"fee schedule"}]}]},{"description":"Babesia microti, amplified probe technique","code_information":[ { "code": "87469", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bacterial Detection PCR - Infectious Agent Antigen Detection; amplified probe technique","code_information":[ { "code": "87801", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Banding Pulmonary Artery","code_information":[ { "code": "33690", "type": "CPT" } ],"standard_charges":[{"minimum":1660.9700,"maximum":1660.9700,"gross_charge":1660.9700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"fee schedule"}]}]},{"description":"Barbiturates","code_information":[ { "code": "80345", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Basic Metabolic Panel","code_information":[ { "code": "80048", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Benzodiazepines; 1 - 12","code_information":[ { "code": "80346", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"b-Hexosaminidase, each assay","code_information":[ { "code": "83080", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bicarbonate","code_information":[ { "code": "82374", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":6.6600,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; direct","code_information":[ { "code": "82248", "type": "CPT" } ],"standard_charges":[{"minimum":5.0000,"maximum":5.0000,"gross_charge":5.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; total","code_information":[ { "code": "82247", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Biopsy , muscle, percutaneous needle","code_information":[ { "code": "20206", "type": "CPT" } ],"standard_charges":[{"minimum":1080.0000,"maximum":1080.0000,"gross_charge":1080.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"}]}]},{"description":"Biopsy of the liver, needle; percutaneous","code_information":[ { "code": "47000", "type": "CPT" } ],"standard_charges":[{"minimum":118.3700,"maximum":118.3700,"gross_charge":118.3700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":118.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":118.3700,"methodology":"fee schedule"}]}]},{"description":"Biopsy of the spinal cord, percutaneous needle","code_information":[ { "code": "62269", "type": "CPT" } ],"standard_charges":[{"minimum":254.9000,"maximum":551.0000,"gross_charge":254.9000,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.9000,"methodology":"fee schedule"}]}]},{"description":"Biopsy thyroid, percutaneous core needle","code_information":[ { "code": "60100", "type": "CPT" } ],"standard_charges":[{"minimum":75.2500,"maximum":551.0000,"gross_charge":75.2500,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.2500,"methodology":"fee schedule"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep","code_information":[ { "code": "20225", "type": "CPT" } ],"standard_charges":[{"minimum":1080.0000,"maximum":1080.0000,"gross_charge":1080.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"}]}]},{"description":"Blastomyces","code_information":[ { "code": "86612", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bleeding Time","code_information":[ { "code": "85002", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Blod count; hematocrit","code_information":[ { "code": "85014", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blod count; Hemoglobin","code_information":[ { "code": "85018", "type": "CPT" } ],"standard_charges":[{"minimum":18.2000,"maximum":18.2000,"gross_charge":18.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; Autorization for deviation from standard blood banking procedures (ex, use of outdated blood, transfusion of RH incompatible untis) with written report","code_information":[ { "code": "86079", "type": "CPT" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; difficult cross match and\/or evaluation of irregular antibody(s), interpretationand written report","code_information":[ { "code": "86077", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Bank physicians services; investigation of transfusion reaction including suspicion of transissible disease, interpretation and written report","code_information":[ { "code": "86078", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)","code_information":[ { "code": "85027", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differencial WBC count","code_information":[ { "code": "85025", "type": "CPT" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; Platelet, automated","code_information":[ { "code": "85049", "type": "CPT" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; Reticulocyte Manual","code_information":[ { "code": "85044", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocyte, automated, including 1 or more cellular parameters, immature reticulocyte fraction, reticulocyte volumen, direct measurement","code_information":[ { "code": "85046", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Culture","code_information":[ { "code": "87106", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":15.3500,"gross_charge":8.4000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Blood smear, pheripheral, interpretation by physician with written report","code_information":[ { "code": "85060", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; ABO","code_information":[ { "code": "86900", "type": "CPT" } ],"standard_charges":[{"minimum":31.5000,"maximum":31.5000,"gross_charge":31.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Blood typing; antigen screening for compatible unit using patient serum, per unit screened","code_information":[ { "code": "86904", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","code_information":[ { "code": "82274", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening","code_information":[ { "code": "82270", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, other sources","code_information":[ { "code": "82271", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bordetella","code_information":[ { "code": "86615", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi","code_information":[ { "code": "86618", "type": "CPT" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi confirmatory test","code_information":[ { "code": "86617", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi, amplified probe technique","code_information":[ { "code": "87476", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Borrelia miyamotoi, amplified probe technique","code_information":[ { "code": "87478", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy FOB w\/Therapy Aspiration Trach","code_information":[ { "code": "31645", "type": "CPT" } ],"standard_charges":[{"minimum":201.4600,"maximum":1342.0000,"gross_charge":201.4600,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with destruction of tumor or relief of stenosis by any method other than excision","code_information":[ { "code": "31641", "type": "CPT" } ],"standard_charges":[{"minimum":341.2400,"maximum":341.2400,"gross_charge":341.2400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with Endobronchial ultrasound guide transtracheal and\/or transbrochial sampling aspiration 3 or more mediastinal and\/or hilar lymph node stations or structures","code_information":[ { "code": "31653", "type": "CPT" } ],"standard_charges":[{"minimum":333.3700,"maximum":333.3700,"gross_charge":333.3700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with excisting tumor","code_information":[ { "code": "31640", "type": "CPT" } ],"standard_charges":[{"minimum":332.0700,"maximum":332.0700,"gross_charge":332.0700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay","code_information":[ { "code": "31646", "type": "CPT" } ],"standard_charges":[{"minimum":194.4700,"maximum":194.4700,"gross_charge":194.4700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with tracheal\/bronchial dilatation or closed reduction of fracture","code_information":[ { "code": "31630", "type": "CPT" } ],"standard_charges":[{"minimum":266.9200,"maximum":266.9200,"gross_charge":266.9200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy(s) single lobe","code_information":[ { "code": "31628", "type": "CPT" } ],"standard_charges":[{"minimum":236.2500,"maximum":236.2500,"gross_charge":236.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, trachea, main stem and\/or lobar bronchus","code_information":[ { "code": "31629", "type": "CPT" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with placement of tracheal stent(s) (includes tracheal\/bronchial dilation as required)","code_information":[ { "code": "31631", "type": "CPT" } ],"standard_charges":[{"minimum":304.0700,"maximum":304.0700,"gross_charge":304.0700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with removal of foreing body","code_information":[ { "code": "31635", "type": "CPT" } ],"standard_charges":[{"minimum":236.2100,"maximum":236.2100,"gross_charge":236.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy each additional lobe","code_information":[ { "code": "31632", "type": "CPT" } ],"standard_charges":[{"minimum":65.5800,"maximum":65.5800,"gross_charge":65.5800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, each additional lobe","code_information":[ { "code": "31633", "type": "CPT" } ],"standard_charges":[{"minimum":85.7600,"maximum":85.7600,"gross_charge":85.7600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; diagnostic, with cell washing, when performed","code_information":[ { "code": "31622", "type": "CPT" } ],"standard_charges":[{"minimum":178.8600,"maximum":178.8600,"gross_charge":178.8600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial alveolar lavage","code_information":[ { "code": "31624", "type": "CPT" } ],"standard_charges":[{"minimum":179.8400,"maximum":179.8400,"gross_charge":179.8400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial or endobronchial biopsy single or multiple sites","code_information":[ { "code": "31625", "type": "CPT" } ],"standard_charges":[{"minimum":210.0800,"maximum":210.0800,"gross_charge":210.0800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with brushing or protected brushing","code_information":[ { "code": "31623", "type": "CPT" } ],"standard_charges":[{"minimum":177.5500,"maximum":177.5500,"gross_charge":177.5500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with computer-assisted, image-guided navigation","code_information":[ { "code": "31627", "type": "CPT" } ],"standard_charges":[{"minimum":129.2900,"maximum":129.2900,"gross_charge":129.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"fee schedule"}]}]},{"description":"Brucella","code_information":[ { "code": "86622", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Buprenorphine","code_information":[ { "code": "80348", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision","code_information":[ { "code": "33891", "type": "CPT" } ],"standard_charges":[{"minimum":932.4600,"maximum":13834.0000,"gross_charge":932.4600,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":932.4600,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortobifemoral","code_information":[ { "code": "35646", "type": "CPT" } ],"standard_charges":[{"minimum":2282.6600,"maximum":2282.6600,"gross_charge":2282.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal","code_information":[ { "code": "35631", "type": "CPT" } ],"standard_charges":[{"minimum":2481.2100,"maximum":2481.2100,"gross_charge":2481.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1481.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortofemoral","code_information":[ { "code": "35647", "type": "CPT" } ],"standard_charges":[{"minimum":2076.4000,"maximum":2076.4000,"gross_charge":2076.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortoiliac","code_information":[ { "code": "35637", "type": "CPT" } ],"standard_charges":[{"minimum":2221.1700,"maximum":2221.1700,"gross_charge":2221.1700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or personal artery","code_information":[ { "code": "35666", "type": "CPT" } ],"standard_charges":[{"minimum":1755.1100,"maximum":1755.1100,"gross_charge":1755.1100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-femoral","code_information":[ { "code": "35661", "type": "CPT" } ],"standard_charges":[{"minimum":1475.6000,"maximum":1475.6000,"gross_charge":1475.6000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-polpliteal","code_information":[ { "code": "35656", "type": "CPT" } ],"standard_charges":[{"minimum":1437.1100,"maximum":1437.1100,"gross_charge":1437.1100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"fee schedule"}]}]},{"description":"C A 19 10","code_information":[ { "code": "86301", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":27.4200,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"C Reactive Protein","code_information":[ { "code": "86140", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Calcitonin","code_information":[ { "code": "82308", "type": "CPT" } ],"standard_charges":[{"minimum":154.0000,"maximum":154.0000,"gross_charge":154.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"fee schedule"}]}]},{"description":"Calcium Urine Random","code_information":[ { "code": "82340", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":8.9700,"gross_charge":12.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Calcium; ionized","code_information":[ { "code": "82330", "type": "CPT" } ],"standard_charges":[{"minimum":82.9500,"maximum":82.9500,"gross_charge":82.9500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"fee schedule"}]}]},{"description":"Calcium; total","code_information":[ { "code": "82310", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Candida species, direct probe technique","code_information":[ { "code": "87480", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cannabinoids, natural","code_information":[ { "code": "80349", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Capillary Lead","code_information":[ { "code": "83655", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":18.0100,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":17.0000,"methodology":"fee 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schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":17.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita 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schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine Tegretol","code_information":[ { "code": "80156", "type": "CPT" } ],"standard_charges":[{"minimum":23.4000,"maximum":21.6500,"gross_charge":23.4000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine; free","code_information":[ { "code": "80157", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Carcinoembryonic Antigen (CEA)","code_information":[ { "code": "82378", "type": "CPT" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiolipin Antibody Ig","code_information":[ { "code": "86147", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; interpretation and report only","code_information":[ { "code": "93018", "type": "CPT" } ],"standard_charges":[{"minimum":264.3100,"maximum":30.2700,"gross_charge":264.3100,"setting":"inpatient","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"per diem"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; supervision only, without interpretation and report","code_information":[ { "code": "93016", "type": "CPT" } ],"standard_charges":[{"minimum":264.3100,"maximum":30.2700,"gross_charge":264.3100,"setting":"inpatient","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"per diem"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; tracing only, without interpretation and report","code_information":[ { "code": "93017", "type": "CPT" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"per diem"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; with supervision, interpretation and report","code_information":[ { "code": "93015", "type": "CPT" } ],"standard_charges":[{"minimum":264.3100,"maximum":146.2500,"gross_charge":264.3100,"setting":"inpatient","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"per diem"}]}]},{"description":"Cardioversion elective, electrical of arrhythmia; external","code_information":[ { "code": "92960", "type": "CPT" } ],"standard_charges":[{"minimum":145.9800,"maximum":145.9800,"gross_charge":145.9800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"fee schedule"}]}]},{"description":"Carnitine (total and free), quantitative, each specimen","code_information":[ { "code": "82379", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Catecholamine; fractionated","code_information":[ { "code": "82384", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","code_information":[ { "code": "93458", "type": "CPT" } ],"standard_charges":[{"minimum":1416.8800,"maximum":1416.8800,"gross_charge":1416.8800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":1416.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":1416.8800,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography","code_information":[ { "code": "93461", "type": "CPT" } ],"standard_charges":[{"minimum":1354.4500,"maximum":487.5000,"gross_charge":1354.4500,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1354.4500,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with rigth and left heart catherrization including intraprocedural injections for left ventricullography, when performd","code_information":[ { "code": "93460", "type": "CPT" } ],"standard_charges":[{"minimum":1690.7500,"maximum":1690.7500,"gross_charge":1690.7500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids; except blood","code_information":[ { "code": "89050", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids; with diferencial count","code_information":[ { "code": "89051", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Central nervous system pathogen, includes multiplex reverse transcription, when performed, and mutiplex amplied probe technique, multiples types or subtypes, 12-25 targets","code_information":[ { "code": "87483", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CFTR gene, analysis; common variants","code_information":[ { "code": "81220", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chemiluminescent assay","code_information":[ { "code": "82397", "type": "CPT" } ],"standard_charges":[{"minimum":80.0800,"maximum":80.0800,"gross_charge":80.0800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"First 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schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"fee schedule"}]}]},{"description":"Chest Tapping","code_information":[ { "code": "94668", "type": "CPT" } ],"standard_charges":[{"minimum":15.0400,"maximum":15.0400,"gross_charge":15.0400,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0400,"methodology":"fee schedule"}]}]},{"description":"Chlamydia","code_information":[ { "code": "86631", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chlamydia IgM","code_information":[ { "code": "86632", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chlamydia trachomatis; amplified Probe Technique","code_information":[ { "code": "87491", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride Urine Random","code_information":[ { "code": "82436", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":7.4800,"gross_charge":12.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride; blood","code_information":[ { "code": "82435", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Chloride; other source","code_information":[ { "code": "82438", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cholesterol Body Fluid","code_information":[ { "code": "84265", "type": "CPT" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Cholesterol Pleural Fluid","code_information":[ { "code": "82465", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":6.4700,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; count 5 cells, 1 Karyotype, with banding","code_information":[ { "code": "88261", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Citrate","code_information":[ { "code": "82507", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CKMB Panel","code_information":[ { "code": "82553", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":17.1700,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":48.0100,"methodology":"fee schedule"}]}]},{"description":"Clostridioides Differential Tox A B","code_information":[ { "code": "87324", "type": "CPT" } ],"standard_charges":[{"minimum":34.9400,"maximum":34.9400,"gross_charge":34.9400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"fee schedule"}]}]},{"description":"Clostridium difficile toxin","code_information":[ { "code": "87230", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Closure of median sternotomy separation with or without debridement (separate procedure)","code_information":[ { "code": "21750", "type": "CPT" } ],"standard_charges":[{"minimum":925.2600,"maximum":925.2600,"gross_charge":925.2600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"fee schedule"}]}]},{"description":"Closure of single ventricular septal defect, with or without patch","code_information":[ { "code": "33681", "type": "CPT" } ],"standard_charges":[{"minimum":2496.3400,"maximum":2496.3400,"gross_charge":2496.3400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity","code_information":[ { "code": "85300", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, antigen assy","code_information":[ { "code": "85301", "type": "CPT" } ],"standard_charges":[{"minimum":168.0000,"maximum":168.0000,"gross_charge":168.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Activity","code_information":[ { "code": "85303", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Antigen","code_information":[ { "code": "85302", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; Protein S Free","code_information":[ { "code": "85306", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Clozapine","code_information":[ { "code": "80159", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; activated","code_information":[ { "code": "85347", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cocaine","code_information":[ { "code": "80353", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Coccidioides","code_information":[ { "code": "86635", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cold Agglutinin Screen","code_information":[ { "code": "86156", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"}]}]},{"description":"Cold Agglutinin Titer","code_information":[ { "code": "86157", "type": "CPT" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial, with removal of terminal ileum or ileocolostomy","code_information":[ { "code": "44160", "type": "CPT" } ],"standard_charges":[{"minimum":1731.8700,"maximum":1731.8700,"gross_charge":1731.8700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with anastomosis","code_information":[ { "code": "44140", "type": "CPT" } ],"standard_charges":[{"minimum":1841.4300,"maximum":1841.4300,"gross_charge":1841.4300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with coloproctostomy, with colostomy","code_information":[ { "code": "44146", "type": "CPT" } ],"standard_charges":[{"minimum":2915.7800,"maximum":2915.7800,"gross_charge":2915.7800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with resection, with colostomy or ileostomy and creation of a mucofistula","code_information":[ { "code": "44144", "type": "CPT" } ],"standard_charges":[{"minimum":2453.4300,"maximum":2453.4300,"gross_charge":2453.4300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with skin-level cecostomy or colostomy","code_information":[ { "code": "44141", "type": "CPT" } ],"standard_charges":[{"minimum":2524.1200,"maximum":2524.1200,"gross_charge":2524.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy","code_information":[ { "code": "44150", "type": "CPT" } ],"standard_charges":[{"minimum":2534.4800,"maximum":2534.4800,"gross_charge":2534.4800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"fee schedule"}]}]},{"description":"Collage cross links, any method","code_information":[ { "code": "82523", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Collection of capillary blood specimens","code_information":[ { "code": "36416", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "45378", "type": "CPT" } ],"standard_charges":[{"minimum":250.0500,"maximum":250.0500,"gross_charge":250.0500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed, with biopsy, single or multiple","code_information":[ { "code": "45380", "type": "CPT" } ],"standard_charges":[{"minimum":271.6400,"maximum":271.6400,"gross_charge":271.6400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"fee schedule"}]}]},{"description":"Colostomy or skin level cecostomy","code_information":[ { "code": "44320", "type": "CPT" } ],"standard_charges":[{"minimum":1648.0200,"maximum":1648.0200,"gross_charge":1648.0200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"fee schedule"}]}]},{"description":"Colpotomy, with exploration","code_information":[ { "code": "57010", "type": "CPT" } ],"standard_charges":[{"minimum":462.3600,"maximum":1103.0000,"gross_charge":462.3600,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.3600,"methodology":"fee schedule"}]}]},{"description":"Column chromatography, including mass spectrometry, if performed, non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","code_information":[ { "code": "82542", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Combined right heart catheterization","code_information":[ { "code": "93533", "type": "CPT" } ],"standard_charges":[{"minimum":1690.7500,"maximum":2070.0000,"gross_charge":1690.7500,"setting":"outpatient","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"}]}]},{"description":"Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies","code_information":[ { "code": "93531", "type": "CPT" } ],"standard_charges":[{"minimum":1722.5700,"maximum":2070.0000,"gross_charge":1722.5700,"setting":"outpatient","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1722.5700,"methodology":"fee schedule"}]}]},{"description":"Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies","code_information":[ { "code": "93532", "type": "CPT" } ],"standard_charges":[{"minimum":1690.7500,"maximum":2070.0000,"gross_charge":1690.7500,"setting":"outpatient","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"}]}]},{"description":"Compatibility test incubated technique","code_information":[ { "code": "86921", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Compatibility test; Antiglobulin technique","code_information":[ { "code": "86922", "type": "CPT" } ],"standard_charges":[{"minimum":102.0000,"maximum":102.0000,"gross_charge":102.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"fee schedule"}]}]},{"description":"Compatibility test; Immediate spin technique","code_information":[ { "code": "86920", "type": "CPT" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"fee schedule"}]}]},{"description":"Complement C3","code_information":[ { "code": "86160", "type": "CPT" } ],"standard_charges":[{"minimum":55.3300,"maximum":17.8600,"gross_charge":55.3300,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Complement; Total hemolytic CH50","code_information":[ { "code": "86162", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Complete Repair anomalous pulmonary venous return","code_information":[ { "code": "33730", "type": "CPT" } ],"standard_charges":[{"minimum":2708.6800,"maximum":2708.6800,"gross_charge":2708.6800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect","code_information":[ { "code": "33697", "type": "CPT" } ],"standard_charges":[{"minimum":2768.2800,"maximum":2768.2800,"gross_charge":2768.2800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of Fallot without pulmonary atresia","code_information":[ { "code": "33692", "type": "CPT" } ],"standard_charges":[{"minimum":2630.6600,"maximum":2630.6600,"gross_charge":2630.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with rigth atrial pacing and recording, rigth ventricular pacing and recording, His bundle recording","code_information":[ { "code": "93620", "type": "CPT" } ],"standard_charges":[{"minimum":9425.8500,"maximum":9425.8500,"gross_charge":9425.8500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"fee schedule"}]}]},{"description":"Comprehensive Metabolic Panel","code_information":[ { "code": "80053", "type": "CPT" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdomen and pelvis with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74174", "type": "CPT" } ],"standard_charges":[{"minimum":566.1500,"maximum":566.1500,"gross_charge":566.1500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74175", "type": "CPT" } ],"standard_charges":[{"minimum":456.3300,"maximum":456.3300,"gross_charge":456.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and images postprogressing","code_information":[ { "code": "75635", "type": "CPT" } ],"standard_charges":[{"minimum":582.5300,"maximum":582.5300,"gross_charge":582.5300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "71275", "type": "CPT" } ],"standard_charges":[{"minimum":417.5900,"maximum":417.5900,"gross_charge":417.5900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70496", "type": "CPT" } ],"standard_charges":[{"minimum":409.9600,"maximum":409.9600,"gross_charge":409.9600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts(when present), with contrast material, including 3D image postprocessing (including evalution of cardiac structure and morphology assessment of cardiac funtion, and evaluation of venuos structures, if performed)","code_information":[ { "code": "75574", "type": "CPT" } ],"standard_charges":[{"minimum":456.0600,"maximum":456.0600,"gross_charge":456.0600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprocessing","code_information":[ { "code": "73706", "type": "CPT" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70498", "type": "CPT" } ],"standard_charges":[{"minimum":409.4900,"maximum":409.4900,"gross_charge":409.4900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, pelvis, with contrast material(s), include noncontrast images, if performed, and image postprogressing","code_information":[ { "code": "72191", "type": "CPT" } ],"standard_charges":[{"minimum":453.9400,"maximum":453.9400,"gross_charge":453.9400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprogressing","code_information":[ { "code": "73206", "type": "CPT" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"fee schedule"}]}]},{"description":"Computed tomography guidance for needle placement, (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","code_information":[ { "code": "77012", "type": "CPT" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":139.3500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; with contrast material","code_information":[ { "code": "74177", "type": "CPT" } ],"standard_charges":[{"minimum":454.4400,"maximum":454.4400,"gross_charge":454.4400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material","code_information":[ { "code": "74176", "type": "CPT" } ],"standard_charges":[{"minimum":270.8300,"maximum":270.8300,"gross_charge":270.8300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and futher sections in one or both body regions","code_information":[ { "code": "74178", "type": "CPT" } ],"standard_charges":[{"minimum":508.8700,"maximum":508.8700,"gross_charge":508.8700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; with contrast material","code_information":[ { "code": "74160", "type": "CPT" } ],"standard_charges":[{"minimum":349.4700,"maximum":349.4700,"gross_charge":349.4700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material","code_information":[ { "code": "74150", "type": "CPT" } ],"standard_charges":[{"minimum":202.2300,"maximum":202.2300,"gross_charge":202.2300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material followed by contrast material and futher sections","code_information":[ { "code": "74170", "type": "CPT" } ],"standard_charges":[{"minimum":391.9900,"maximum":391.9900,"gross_charge":391.9900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; with contrast material","code_information":[ { "code": "72126", "type": "CPT" } ],"standard_charges":[{"minimum":250.0300,"maximum":250.0300,"gross_charge":250.0300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; without contrast material","code_information":[ { "code": "72125", "type": "CPT" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72127", "type": "CPT" } ],"standard_charges":[{"minimum":293.0300,"maximum":293.0300,"gross_charge":293.0300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; with contrast material","code_information":[ { "code": "70460", "type": "CPT" } ],"standard_charges":[{"minimum":218.9900,"maximum":218.9900,"gross_charge":218.9900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; without contrast material","code_information":[ { "code": "70450", "type": "CPT" } ],"standard_charges":[{"minimum":156.9500,"maximum":156.9500,"gross_charge":156.9500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70470", "type": "CPT" } ],"standard_charges":[{"minimum":257.6600,"maximum":257.6600,"gross_charge":257.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, heart, with contrast materials, for evaluate of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","code_information":[ { "code": "75572", "type": "CPT" } ],"standard_charges":[{"minimum":335.3800,"maximum":335.3800,"gross_charge":335.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","code_information":[ { "code": "75571", "type": "CPT" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; with contrast material","code_information":[ { "code": "73701", "type": "CPT" } ],"standard_charges":[{"minimum":247.1800,"maximum":247.1800,"gross_charge":247.1800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material","code_information":[ { "code": "73700", "type": "CPT" } ],"standard_charges":[{"minimum":191.3200,"maximum":191.3200,"gross_charge":191.3200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","code_information":[ { "code": "73702", "type": "CPT" } ],"standard_charges":[{"minimum":289.7300,"maximum":289.7300,"gross_charge":289.7300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; with contrast material","code_information":[ { "code": "72132", "type": "CPT" } ],"standard_charges":[{"minimum":250.5200,"maximum":250.5200,"gross_charge":250.5200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material","code_information":[ { "code": "72131", "type": "CPT" } ],"standard_charges":[{"minimum":190.8500,"maximum":190.8500,"gross_charge":190.8500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72133", "type": "CPT" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; with contrast material","code_information":[ { "code": "70487", "type": "CPT" } ],"standard_charges":[{"minimum":225.2000,"maximum":225.2000,"gross_charge":225.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; without contrast material","code_information":[ { "code": "70486", "type": "CPT" } ],"standard_charges":[{"minimum":189.9500,"maximum":189.9500,"gross_charge":189.9500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70488", "type": "CPT" } ],"standard_charges":[{"minimum":274.3900,"maximum":274.3900,"gross_charge":274.3900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; with contrast material","code_information":[ { "code": "70481", "type": "CPT" } ],"standard_charges":[{"minimum":268.2400,"maximum":268.2400,"gross_charge":268.2400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material","code_information":[ { "code": "70480", "type": "CPT" } ],"standard_charges":[{"minimum":234.7100,"maximum":234.7100,"gross_charge":234.7100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70482", "type": "CPT" } ],"standard_charges":[{"minimum":313.1200,"maximum":313.1200,"gross_charge":313.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; with contrast material(s)","code_information":[ { "code": "72193", "type": "CPT" } ],"standard_charges":[{"minimum":343.3100,"maximum":343.3100,"gross_charge":343.3100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; without contrast material","code_information":[ { "code": "72192", "type": "CPT" } ],"standard_charges":[{"minimum":197.0100,"maximum":197.0100,"gross_charge":197.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72194", "type": "CPT" } ],"standard_charges":[{"minimum":378.6700,"maximum":378.6700,"gross_charge":378.6700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; with contrast material(s)","code_information":[ { "code": "70491", "type": "CPT" } ],"standard_charges":[{"minimum":273.8700,"maximum":273.8700,"gross_charge":273.8700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material","code_information":[ { "code": "70490", "type": "CPT" } ],"standard_charges":[{"minimum":222.2800,"maximum":222.2800,"gross_charge":222.2800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and futher sections","code_information":[ { "code": "70492", "type": "CPT" } ],"standard_charges":[{"minimum":329.2400,"maximum":329.2400,"gross_charge":329.2400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; with contrast material","code_information":[ { "code": "72129", "type": "CPT" } ],"standard_charges":[{"minimum":251.9300,"maximum":251.9300,"gross_charge":251.9300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; without contrast material","code_information":[ { "code": "72128", "type": "CPT" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72130", "type": "CPT" } ],"standard_charges":[{"minimum":295.9000,"maximum":295.9000,"gross_charge":295.9000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; with contrast material(s)","code_information":[ { "code": "71260", "type": "CPT" } ],"standard_charges":[{"minimum":240.7400,"maximum":240.7400,"gross_charge":240.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material","code_information":[ { "code": "71250", "type": "CPT" } ],"standard_charges":[{"minimum":191.5100,"maximum":191.5100,"gross_charge":191.5100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "71270", "type": "CPT" } ],"standard_charges":[{"minimum":291.6200,"maximum":291.6200,"gross_charge":291.6200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; with contrast material(s)","code_information":[ { "code": "73201", "type": "CPT" } ],"standard_charges":[{"minimum":299.7800,"maximum":299.7800,"gross_charge":299.7800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; without contrast material","code_information":[ { "code": "73200", "type": "CPT" } ],"standard_charges":[{"minimum":240.1000,"maximum":240.1000,"gross_charge":240.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "73202", "type": "CPT" } ],"standard_charges":[{"minimum":371.9800,"maximum":371.9800,"gross_charge":371.9800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"fee schedule"}]}]},{"description":"Contrast injection for assessment of abscess or cyst via previosly placed drainage catherter or tube","code_information":[ { "code": "49424", "type": "CPT" } ],"standard_charges":[{"minimum":200.0000,"maximum":2205.0000,"gross_charge":200.0000,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.0000,"methodology":"fee schedule"}]}]},{"description":"Control nasal hemorrhage, anterior, complex (extensive cautery\/or packing) any method","code_information":[ { "code": "30903", "type": "CPT" } ],"standard_charges":[{"minimum":107.1300,"maximum":107.1300,"gross_charge":107.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"fee schedule"}]}]},{"description":"Copper","code_information":[ { "code": "82525", "type": "CPT" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, using arterial grafts; single arterial graft","code_information":[ { "code": "33533", "type": "CPT" } ],"standard_charges":[{"minimum":2523.0000,"maximum":2523.0000,"gross_charge":2523.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 2 coronary venous graft","code_information":[ { "code": "33511", "type": "CPT" } ],"standard_charges":[{"minimum":2860.4500,"maximum":2860.4500,"gross_charge":2860.4500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 3 coronary venous graft","code_information":[ { "code": "33512", "type": "CPT" } ],"standard_charges":[{"minimum":3258.2500,"maximum":3258.2500,"gross_charge":3258.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 4 coronary venous graft","code_information":[ { "code": "33513", "type": "CPT" } ],"standard_charges":[{"minimum":3354.4400,"maximum":3354.4400,"gross_charge":3354.4400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; 5 coronary venous graft","code_information":[ { "code": "33514", "type": "CPT" } ],"standard_charges":[{"minimum":3497.7000,"maximum":3497.7000,"gross_charge":3497.7000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"fee schedule"}]}]},{"description":"Coronary Artery Bypass, vein only ; single coronary venous","code_information":[ { "code": "33510", "type": "CPT" } ],"standard_charges":[{"minimum":2604.9500,"maximum":2604.9500,"gross_charge":2604.9500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"fee schedule"}]}]},{"description":"Cortisol; free","code_information":[ { "code": "82530", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cortisol; total","code_information":[ { "code": "82533", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"C-peptide","code_information":[ { "code": "84681", "type": "CPT" } ],"standard_charges":[{"minimum":83.2000,"maximum":83.2000,"gross_charge":83.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"fee schedule"}]}]},{"description":"Creatine Kinase","code_information":[ { "code": "82550", "type": "CPT" } ],"standard_charges":[{"minimum":26.6000,"maximum":16.0000,"gross_charge":26.6000,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creatinine","code_information":[ { "code": "82575", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":14.0600,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creatinine Body Fluid","code_information":[ { "code": "82570", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":7.7000,"gross_charge":4.2000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Creatinine; blood","code_information":[ { "code": "82565", "type": "CPT" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"}]}]},{"description":"Creation of pericardial window or partial resection for drainage","code_information":[ { "code": "33025", "type": "CPT" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"}]}]},{"description":"Cryoglobulin, qualitative or sem-quantitative","code_information":[ { "code": "82595", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cryptococcus Cytomegalovirus (CMV) IgM","code_information":[ { "code": "86645", "type": "CPT" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Cryptococcus Cytomegalovirus IgG Antibody","code_information":[ { "code": "86644", "type": "CPT" } ],"standard_charges":[{"minimum":23.8000,"maximum":23.8000,"gross_charge":23.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"}]}]},{"description":"Cryptosporidium Antigen Stool","code_information":[ { "code": "87328", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Crystal identification by light microscopy wit or without polarizing lens analysis, tissue or any body fluid","code_information":[ { "code": "89060", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; stool, aerobic with isolation and preliminary examination","code_information":[ { "code": "87045", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"}]}]},{"description":"Culture bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate","code_information":[ { "code": "87046", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","code_information":[ { "code": "87077", "type": "CPT" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; quantitative colony count, urine","code_information":[ { "code": "87086", "type": "CPT" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; quantitative, aerobic with isolationand presumptive identification of isolates, any source except urine, blood or stool","code_information":[ { "code": "87071", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; other source","code_information":[ { "code": "87102", "type": "CPT" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; Blood","code_information":[ { "code": "87103", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; skin, hair, or nail","code_information":[ { "code": "87101", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Culture, presumptive, pathogenic organism screening only","code_information":[ { "code": "87081", "type": "CPT" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"Culture, tubercle or other acid-fast bacilli, any source, with isolative presumptive identification of isolates","code_information":[ { "code": "87116", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cyanocobalamin","code_information":[ { "code": "82607", "type": "CPT" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"}]}]},{"description":"Cyclic Citrullinated Peptide, antibody","code_information":[ { "code": "86200", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cyclosporine","code_information":[ { "code": "80158", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"CYP2C19 gene, analysis; common variants","code_information":[ { "code": "81225", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytolopathology, selective cellular enhancement technique with interpretation; except cervical or vaginal","code_information":[ { "code": "88112", "type": "CPT" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytomegalovirus, amplified probe technique","code_information":[ { "code": "87496", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Cytomegalovirus, quantification","code_information":[ { "code": "87497", "type": "CPT" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"}]}]},{"description":"Debridement subcutaneous tissue; first 20 sq cm or less","code_information":[ { "code": "11042", "type": "CPT" } ],"standard_charges":[{"minimum":84.4600,"maximum":84.4600,"gross_charge":84.4600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"fee schedule"}]}]},{"description":"Debridment bone; first 20 sq cm or less","code_information":[ { "code": "11044", "type": "CPT" } ],"standard_charges":[{"minimum":308.1400,"maximum":308.1400,"gross_charge":308.1400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forear and or wrist, flexor or exttensor compartment; without debridement of nonviable muscle and or nerve","code_information":[ { "code": "25020", "type": "CPT" } ],"standard_charges":[{"minimum":1048.3200,"maximum":1048.3200,"gross_charge":1048.3200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"fee schedule"}]}]},{"description":"Decortication parietal pleurectomy","code_information":[ { "code": "32320", "type": "CPT" } ],"standard_charges":[{"minimum":2179.1800,"maximum":2179.1800,"gross_charge":2179.1800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"fee schedule"}]}]},{"description":"Decortication, pulmonary partial","code_information":[ { "code": "32225", "type": "CPT" } ],"standard_charges":[{"minimum":1352.7200,"maximum":1352.7200,"gross_charge":1352.7200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"fee schedule"}]}]},{"description":"Decortication, pulmonary total","code_information":[ { "code": "32220", "type": "CPT" } ],"standard_charges":[{"minimum":2173.0700,"maximum":2173.0700,"gross_charge":2173.0700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"fee schedule"}]}]},{"description":"Dehydroepiandrosterone Sulfate (DHEA-S)","code_information":[ { "code": "82627", "type": "CPT" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Deoxyribonuclease Antibody","code_information":[ { "code": "86215", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Descending thoracic aorta graft, with or without bypass","code_information":[ { "code": "33875", "type": "CPT" } ],"standard_charges":[{"minimum":2677.7300,"maximum":18446.0000,"gross_charge":2677.7300,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2677.7300,"methodology":"fee schedule"}]}]},{"description":"Diagnostic bone marrow; biopsy","code_information":[ { "code": "38222", "type": "CPT" } ],"standard_charges":[{"minimum":232.1300,"maximum":551.0000,"gross_charge":232.1300,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.1300,"methodology":"fee schedule"}]}]},{"description":"Dialisis","code_information":[ { "code": "90935", "type": "CPT" } ],"standard_charges":[{"minimum":359.8000,"maximum":359.8000,"gross_charge":359.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"per diem"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"}]}]},{"description":"Dialysis procedure other than hemodialysis, requiring repeated evaluation by a physian or other qualified health care professional, with or without substantial revision of dialysis prescription","code_information":[ { "code": "90947", "type": "CPT" } ],"standard_charges":[{"minimum":359.8000,"maximum":450.0000,"gross_charge":359.8000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"per diem"}]}]},{"description":"Dialysis procedure other than hemodialysis, with single evaluation by a physian or other qualified health care professional","code_information":[ { "code": "90945", "type": "CPT" } ],"standard_charges":[{"minimum":359.8000,"maximum":450.0000,"gross_charge":359.8000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"per diem"}]}]},{"description":"Diaphragm imbrication for eventration, transthoracic or transabdominal, paralytic or nonparalytic","code_information":[ { "code": "39545", "type": "CPT" } ],"standard_charges":[{"minimum":1222.3300,"maximum":1222.3300,"gross_charge":1222.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"fee schedule"}]}]},{"description":"Diaphragma resection with simple repair","code_information":[ { "code": "39560", "type": "CPT" } ],"standard_charges":[{"minimum":1102.6800,"maximum":1102.6800,"gross_charge":1102.6800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"fee schedule"}]}]},{"description":"Digoxin; total","code_information":[ { "code": "80162", "type": "CPT" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"Diphtheria enterovirus","code_information":[ { "code": "86658", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage","code_information":[ { "code": "33645", "type": "CPT" } ],"standard_charges":[{"minimum":2335.3800,"maximum":2335.3800,"gross_charge":2335.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft, for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta","code_information":[ { "code": "35081", "type": "CPT" } ],"standard_charges":[{"minimum":1683.7400,"maximum":18446.0000,"gross_charge":1683.7400,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1683.7400,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft, for a ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypograstric, external)","code_information":[ { "code": "35103", "type": "CPT" } ],"standard_charges":[{"minimum":1680.2000,"maximum":18446.0000,"gross_charge":1680.2000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft, for aneurysm, pseudoaneurysm, and associated occlusive disease in the abdominal aorta involving visceral vessels (mesenteric, celiac, renal)","code_information":[ { "code": "35091", "type": "CPT" } ],"standard_charges":[{"minimum":1728.8700,"maximum":18446.0000,"gross_charge":1728.8700,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1728.8700,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft, for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)","code_information":[ { "code": "35102", "type": "CPT" } ],"standard_charges":[{"minimum":1830.5800,"maximum":18446.0000,"gross_charge":1830.5800,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1830.5800,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft, for ruptured aneurysm, abdominal aorta","code_information":[ { "code": "35082", "type": "CPT" } ],"standard_charges":[{"minimum":2101.6800,"maximum":18446.0000,"gross_charge":2101.6800,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2101.6800,"methodology":"fee schedule"}]}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)","code_information":[ { "code": "35141", "type": "CPT" } ],"standard_charges":[{"minimum":1488.8600,"maximum":1488.8600,"gross_charge":1488.8600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"fee schedule"}]}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy, thoracic approach","code_information":[ { "code": "43135", "type": "CPT" } ],"standard_charges":[{"minimum":1992.2700,"maximum":1992.2700,"gross_charge":1992.2700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"fee schedule"}]}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy; cervical approach","code_information":[ { "code": "43130", "type": "CPT" } ],"standard_charges":[{"minimum":1097.1200,"maximum":1097.1200,"gross_charge":1097.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"fee schedule"}]}]},{"description":"DNA Antibody; native or double stranded","code_information":[ { "code": "86225", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography color flow velocity mapping","code_information":[ { "code": "93325", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":50.0000,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography, pulsed wave and\/or continuous wave with spectral display; complete","code_information":[ { "code": "93320", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":100.0000,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography, pulsed wave and\/or continuous wave with spectral display; follow up or limited study","code_information":[ { "code": "93321", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":45.0000,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"}]}]},{"description":"Drain of Mediastinal Abscess","code_information":[ { "code": "10060", "type": "CPT" } ],"standard_charges":[{"minimum":148.1100,"maximum":630.0000,"gross_charge":148.1100,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"}]}]},{"description":"Drainage of a retroperitoneal abscess, open","code_information":[ { "code": "49060", "type": "CPT" } ],"standard_charges":[{"minimum":1528.8000,"maximum":1528.8000,"gross_charge":1528.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"fee schedule"}]}]},{"description":"Drainage of Finger abscess; simple","code_information":[ { "code": "26010", "type": "CPT" } ],"standard_charges":[{"minimum":200.9600,"maximum":200.9600,"gross_charge":200.9600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"fee schedule"}]}]},{"description":"Drainage of peritoneal abscess or localized peritonitis, exclusive appendiceal abscess, open","code_information":[ { "code": "49020", "type": "CPT" } ],"standard_charges":[{"minimum":2226.6900,"maximum":2226.6900,"gross_charge":2226.6900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"fee schedule"}]}]},{"description":"Drug test presumptive any number of drug classes, any number of devices or procedures; By instrument chemistry analyzers","code_information":[ { "code": "80307", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of extracranial arteries; complete bilateral study","code_information":[ { "code": "93880", "type": "CPT" } ],"standard_charges":[{"minimum":267.1200,"maximum":267.1200,"gross_charge":267.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of extracranial arteries; unilateral or limited study","code_information":[ { "code": "93882", "type": "CPT" } ],"standard_charges":[{"minimum":175.2500,"maximum":175.2500,"gross_charge":175.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study","code_information":[ { "code": "93971", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":65.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Echocardiography transthoracic, real time with image documentation (2D), includes M mode recording, when performed follow up or limited study","code_information":[ { "code": "93308", "type": "CPT" } ],"standard_charges":[{"minimum":99.0600,"maximum":71.0000,"gross_charge":99.0600,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.0600,"methodology":"fee schedule"}]}]},{"description":"Echocardiography transthoracic, real time with image documentation (2D), includes M mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography","code_information":[ { "code": "93306", "type": "CPT" } ],"standard_charges":[{"minimum":197.0300,"maximum":300.0000,"gross_charge":197.0300,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0300,"methodology":"fee schedule"}]}]},{"description":"Echocardiography transthoracic, real time with image documentation (2D), includes M mode recording, when performed, complete, without spectral doppler echocardiography, and with color flow doppler echocardiography","code_information":[ { "code": "93307", "type": "CPT" } ],"standard_charges":[{"minimum":136.8400,"maximum":150.0000,"gross_charge":136.8400,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":136.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":136.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":136.8400,"methodology":"fee schedule"}]}]},{"description":"Echocardiography transthoracic, real time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using traedmill, bicycle exercise and\/or pharmacologically includes stress, with interpretation and report","code_information":[ { "code": "93350", "type": "CPT" } ],"standard_charges":[{"minimum":185.9800,"maximum":170.6300,"gross_charge":185.9800,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.9800,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transesophageal, real time with image documentation (2D); image acquisition, interpretation and report only","code_information":[ { "code": "93314", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":132.0000,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"}]}]},{"description":"Echocardiography, transesophageal, real time with image documentation (2D); including probe placement, image acquisition, interpretation and report","code_information":[ { "code": "93312", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":190.0000,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transesophageal, real time with image documentation (2D); placement of transesophageal probe only","code_information":[ { "code": "93313", "type": "CPT" } ],"standard_charges":[{"minimum":336.6300,"maximum":52.8900,"gross_charge":336.6300,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.6300,"methodology":"per diem"}]}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when preformed, during rest and cardiovascular stress test using treadmill, bicycle exercise and\/or pharmacologically induce stress, with interpretation and report; including performance of continuos electrocardiographic monitoring, with supervision by a physician or other qualified health care professional","code_information":[ { "code": "93351", "type": "CPT" } ],"standard_charges":[{"minimum":330.6200,"maximum":330.6200,"gross_charge":330.6200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"fee schedule"}]}]},{"description":"EGD Biopsy","code_information":[ { "code": "43239", "type": "CPT" } ],"standard_charges":[{"minimum":188.1600,"maximum":1342.0000,"gross_charge":188.1600,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"fee schedule"}]}]},{"description":"Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report","code_information":[ { "code": "93000", "type": "CPT" } ],"standard_charges":[{"minimum":19.7700,"maximum":19.7700,"gross_charge":19.7700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"fee schedule"}]}]},{"description":"Electrolytes panel","code_information":[ { "code": "80051", "type": "CPT" } ],"standard_charges":[{"minimum":22.6100,"maximum":22.6100,"gross_charge":22.6100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter, carotid, subclavian or innominate artery, by neck incision","code_information":[ { "code": "34001", "type": "CPT" } ],"standard_charges":[{"minimum":1227.7200,"maximum":1227.7200,"gross_charge":1227.7200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"fee schedule"}]}]},{"description":"Embolization","code_information":[ { "code": "37241", "type": "CPT" } ],"standard_charges":[{"minimum":569.5200,"maximum":1200.0000,"gross_charge":569.5200,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"fee schedule"}]}]},{"description":"Emergency Room Services","code_information":[ { "code": "99284", "type": "CPT" } ],"standard_charges":[{"minimum":288.5000,"maximum":232.0000,"gross_charge":288.5000,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"}]}]},{"description":"Emergency Room Services","code_information":[ { "code": "99285", "type": "CPT" } ],"standard_charges":[{"minimum":288.5000,"maximum":232.0000,"gross_charge":288.5000,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"}]}]},{"description":"Endomiocardial Biopsy","code_information":[ { "code": "93505", "type": "CPT" } ],"standard_charges":[{"minimum":880.4000,"maximum":2070.0000,"gross_charge":880.4000,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"fee schedule"}]}]},{"description":"Endomysial Antibody, each immunoglobulin","code_information":[ { "code": "86231", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign bodies or stents from the biliary\/pancreatic ducts","code_information":[ { "code": "43275", "type": "CPT" } ],"standard_charges":[{"minimum":516.3200,"maximum":516.3200,"gross_charge":516.3200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of the descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic discruption); involving the coverage of the left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s) if required, to level of celiac artery origin","code_information":[ { "code": "33880", "type": "CPT" } ],"standard_charges":[{"minimum":2431.4900,"maximum":2431.4900,"gross_charge":2431.4900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of the descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic discruption); not involving the coverage of the left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s) if required, to level of celiac artery origin","code_information":[ { "code": "33881", "type": "CPT" } ],"standard_charges":[{"minimum":1491.8900,"maximum":13834.0000,"gross_charge":1491.8900,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1491.8900,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of the infrarenal aorta and\/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation; for the than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetr","code_information":[ { "code": "34703", "type": "CPT" } ],"standard_charges":[{"minimum":13000.0000,"maximum":13000.0000,"gross_charge":13000.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13000.0000,"methodology":"fee schedule"}]}]},{"description":"Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches","code_information":[ { "code": "33894", "type": "CPT" } ],"standard_charges":[{"minimum":1314.6300,"maximum":1314.6300,"gross_charge":1314.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"fee schedule"}]}]},{"description":"Endovenous ablation therapy of incompetent vein in an extremity using radiofrequency for the first vein treated","code_information":[ { "code": "36475", "type": "CPT" } ],"standard_charges":[{"minimum":373.2100,"maximum":373.2100,"gross_charge":373.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"fee schedule"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity; by transcatheter delivery of a chemical adhesive remote form the access site, inclusive of all imging guidacne and monitoring percutaneous; first vein treated","code_information":[ { "code": "36482", "type": "CPT" } ],"standard_charges":[{"minimum":240.8700,"maximum":240.8700,"gross_charge":240.8700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"fee schedule"}]}]},{"description":"Enterovirus, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87498", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive subtrate, each specimen","code_information":[ { "code": "82657", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Eosinophil Count","code_information":[ { "code": "89190", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":7.0700,"gross_charge":10.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Epstein","code_information":[ { "code": "86665", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Epstein Barr Virus Early Antigen Antibody","code_information":[ { "code": "86663", "type": "CPT" } ],"standard_charges":[{"minimum":90.0100,"maximum":90.0100,"gross_charge":90.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"fee schedule"}]}]},{"description":"Epstein-Barr Virus Nuclear Antigen Antibody","code_information":[ { "code": "86664", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ergonovine provocation test","code_information":[ { "code": "93024", "type": "CPT" } ],"standard_charges":[{"minimum":264.3100,"maximum":120.0000,"gross_charge":264.3100,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3100,"methodology":"per diem"}]}]},{"description":"Esophagectomy, distal two-thirds, , with laparospic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43287", "type": "CPT" } ],"standard_charges":[{"minimum":4813.5500,"maximum":4813.5500,"gross_charge":4813.5500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"fee schedule"}]}]},{"description":"Esophagectomy, total or near total, with laparospic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43286", "type": "CPT" } ],"standard_charges":[{"minimum":4308.1900,"maximum":4308.1900,"gross_charge":4308.1900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"fee schedule"}]}]},{"description":"Esophagectomy, total or near total, with thoracospic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparospic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43288", "type": "CPT" } ],"standard_charges":[{"minimum":5160.8200,"maximum":5160.8200,"gross_charge":5160.8200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"fee schedule"}]}]},{"description":"Esophagogastric fundoplasty partial or complete; laparotomy","code_information":[ { "code": "43327", "type": "CPT" } ],"standard_charges":[{"minimum":1141.5300,"maximum":1141.5300,"gross_charge":1141.5300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy with directed placement of percutaneous gastrostomy tube","code_information":[ { "code": "43246", "type": "CPT" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with band ligation of esophageal\/gastric varices","code_information":[ { "code": "43244", "type": "CPT" } ],"standard_charges":[{"minimum":336.8000,"maximum":336.8000,"gross_charge":336.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "43235", "type": "CPT" } ],"standard_charges":[{"minimum":169.3700,"maximum":169.3700,"gross_charge":169.3700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with control of bleeding, any method","code_information":[ { "code": "43255", "type": "CPT" } ],"standard_charges":[{"minimum":270.7500,"maximum":270.7500,"gross_charge":270.7500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with dilation of gastric\/duodenal stricture(s)","code_information":[ { "code": "43245", "type": "CPT" } ],"standard_charges":[{"minimum":238.1000,"maximum":238.1000,"gross_charge":238.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire","code_information":[ { "code": "43248", "type": "CPT" } ],"standard_charges":[{"minimum":229.0500,"maximum":229.0500,"gross_charge":229.0500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with placement of an endoscopic stent","code_information":[ { "code": "43266", "type": "CPT" } ],"standard_charges":[{"minimum":294.5200,"maximum":294.5200,"gross_charge":294.5200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with removal of foreign body(s)","code_information":[ { "code": "43247", "type": "CPT" } ],"standard_charges":[{"minimum":239.5100,"maximum":239.5100,"gross_charge":239.5100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, with transendoscopic balloon dilation of the esophagus (less than 30 mm in diameter)","code_information":[ { "code": "43249", "type": "CPT" } ],"standard_charges":[{"minimum":208.3300,"maximum":208.3300,"gross_charge":208.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"fee schedule"}]}]},{"description":"Esophagomyotomy (heller type); thoracic approach","code_information":[ { "code": "43331", "type": "CPT" } ],"standard_charges":[{"minimum":1821.9700,"maximum":1821.9700,"gross_charge":1821.9700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with insertion of guide wire followed by passage of dilator(s) over guide wire","code_information":[ { "code": "43226", "type": "CPT" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with removal of foreign body(s)","code_information":[ { "code": "43215", "type": "CPT" } ],"standard_charges":[{"minimum":192.2100,"maximum":192.2100,"gross_charge":192.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral, with transendoscopic balloon dilation","code_information":[ { "code": "43220", "type": "CPT" } ],"standard_charges":[{"minimum":160.6200,"maximum":160.6200,"gross_charge":160.6200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimens by brushing or washing, when performed","code_information":[ { "code": "43200", "type": "CPT" } ],"standard_charges":[{"minimum":120.2300,"maximum":120.2300,"gross_charge":120.2300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus, with cricopharyngeal myotomy, includes use of telescope or oparating microscope and repair","code_information":[ { "code": "43180", "type": "CPT" } ],"standard_charges":[{"minimum":767.4800,"maximum":767.4800,"gross_charge":767.4800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen((s) by brushing or washing when preformed","code_information":[ { "code": "43191", "type": "CPT" } ],"standard_charges":[{"minimum":213.8800,"maximum":213.8800,"gross_charge":213.8800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with balloon dilation (less than 30mm diameter)","code_information":[ { "code": "43195", "type": "CPT" } ],"standard_charges":[{"minimum":254.2400,"maximum":254.2400,"gross_charge":254.2400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with biopsy, single or multiple","code_information":[ { "code": "43202", "type": "CPT" } ],"standard_charges":[{"minimum":140.4500,"maximum":140.4500,"gross_charge":140.4500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed","code_information":[ { "code": "43212", "type": "CPT" } ],"standard_charges":[{"minimum":255.8600,"maximum":255.8600,"gross_charge":255.8600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"fee schedule"}]}]},{"description":"Esophagostomy, fistulization of esophagus, external; cervical approach","code_information":[ { "code": "43352", "type": "CPT" } ],"standard_charges":[{"minimum":1456.3100,"maximum":1456.3100,"gross_charge":1456.3100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"fee schedule"}]}]},{"description":"Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode(s) placement, recording, analysis and interpretation","code_information":[ { "code": "91034", "type": "CPT" } ],"standard_charges":[{"minimum":268.9700,"maximum":268.9700,"gross_charge":268.9700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"fee schedule"}]}]},{"description":"Estrogens; Total","code_information":[ { "code": "82672", "type": "CPT" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Ethosuximide","code_information":[ { "code": "80168", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ethylene Glycol","code_information":[ { "code": "82693", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Evasc rpr a-ao ndgft rpt","code_information":[ { "code": "34702", "type": "CPT" } ],"standard_charges":[{"minimum":13000.0000,"maximum":13000.0000,"gross_charge":13000.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13000.0000,"methodology":"fee schedule"}]}]},{"description":"Excision brancial cleft cyst or vestige, confined to skin and subcutaneous tissues","code_information":[ { "code": "42810", "type": "CPT" } ],"standard_charges":[{"minimum":401.9100,"maximum":401.9100,"gross_charge":401.9100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"fee schedule"}]}]},{"description":"Excision chest wall tumor involving rib, with plastic reconstruction; without mediastinal lymphadenectomy","code_information":[ { "code": "21602", "type": "CPT" } ],"standard_charges":[{"minimum":2105.1100,"maximum":2105.1100,"gross_charge":2105.1100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"fee schedule"}]}]},{"description":"Excision Foreign Body, foot; deep","code_information":[ { "code": "28192", "type": "CPT" } ],"standard_charges":[{"minimum":438.1000,"maximum":438.1000,"gross_charge":438.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"fee schedule"}]}]},{"description":"Excision Ganglion, wrist (dorsal or volar); primary","code_information":[ { "code": "25111", "type": "CPT" } ],"standard_charges":[{"minimum":469.2200,"maximum":469.2200,"gross_charge":469.2200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"fee schedule"}]}]},{"description":"Excision of an infected graft; neck","code_information":[ { "code": "35901", "type": "CPT" } ],"standard_charges":[{"minimum":655.1300,"maximum":655.1300,"gross_charge":655.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"fee schedule"}]}]},{"description":"Excision of chest wall tumor including\/involving rib(s)","code_information":[ { "code": "21601", "type": "CPT" } ],"standard_charges":[{"minimum":1579.9400,"maximum":1579.9400,"gross_charge":1579.9400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"fee schedule"}]}]},{"description":"Excision of coarctation of the aorta, with or without associated patent ductus arteriosus, with direct anastomosis","code_information":[ { "code": "33840", "type": "CPT" } ],"standard_charges":[{"minimum":1710.6000,"maximum":1710.6000,"gross_charge":1710.6000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"fee schedule"}]}]},{"description":"Excision of intracardiac tumor, resection with cardiopulmonary bypass","code_information":[ { "code": "33120", "type": "CPT" } ],"standard_charges":[{"minimum":2860.9600,"maximum":2860.9600,"gross_charge":2860.9600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion, esophagus with primary repair; thoracic or abdominal approach","code_information":[ { "code": "43101", "type": "CPT" } ],"standard_charges":[{"minimum":1370.8900,"maximum":1370.8900,"gross_charge":1370.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot","code_information":[ { "code": "28090", "type": "CPT" } ],"standard_charges":[{"minimum":437.2200,"maximum":437.2200,"gross_charge":437.2200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"fee schedule"}]}]},{"description":"Excision of rib, partial","code_information":[ { "code": "21600", "type": "CPT" } ],"standard_charges":[{"minimum":788.8200,"maximum":788.8200,"gross_charge":788.8200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"fee schedule"}]}]},{"description":"Excision of synovial cyst of popliteal space (Baker's Cyst)","code_information":[ { "code": "27345", "type": "CPT" } ],"standard_charges":[{"minimum":684.4700,"maximum":684.4700,"gross_charge":684.4700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"fee schedule"}]}]},{"description":"Excision of tracheal tumor or carcinoma; cervical","code_information":[ { "code": "31785", "type": "CPT" } ],"standard_charges":[{"minimum":1502.9300,"maximum":1502.9300,"gross_charge":1502.9300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"fee schedule"}]}]},{"description":"Excision tracheal stenosis and anastomosis; cervical","code_information":[ { "code": "31780", "type": "CPT" } ],"standard_charges":[{"minimum":1651.2700,"maximum":1651.2700,"gross_charge":1651.2700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"fee schedule"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia","code_information":[ { "code": "11420", "type": "CPT" } ],"standard_charges":[{"minimum":115.9300,"maximum":115.9300,"gross_charge":115.9300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"fee schedule"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less","code_information":[ { "code": "11400", "type": "CPT" } ],"standard_charges":[{"minimum":117.2900,"maximum":117.2900,"gross_charge":117.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"fee schedule"}]}]},{"description":"Exploratory","code_information":[ { "code": "44910", "type": "CPT" } ],"standard_charges":[{"minimum":1286.1000,"maximum":1286.1000,"gross_charge":1286.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"fee schedule"}]}]},{"description":"Exploratory Laparotomy, exploratory celiotomy with or without biopsy(s)","code_information":[ { "code": "49000", "type": "CPT" } ],"standard_charges":[{"minimum":1076.5300,"maximum":1076.5300,"gross_charge":1076.5300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"fee schedule"}]}]},{"description":"Extrapleural enucleation of empyema","code_information":[ { "code": "32540", "type": "CPT" } ],"standard_charges":[{"minimum":1698.9000,"maximum":772.0000,"gross_charge":1698.9000,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1698.9000,"methodology":"fee schedule"}]}]},{"description":"F2 gene analysis 20210G>A variant","code_information":[ { "code": "81240", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"F5 gene analysis, Leiden variant","code_information":[ { "code": "81241", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"F9 full gene sequence","code_information":[ { "code": "81238", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualitatives","code_information":[ { "code": "82705", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualititative","code_information":[ { "code": "82710", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fatty acids, nonesterified","code_information":[ { "code": "82725", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Felbamate","code_information":[ { "code": "80167", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ferritin","code_information":[ { "code": "82728", "type": "CPT" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"}]}]},{"description":"Fetal congenital abnormalities, biochemical assys of three proteins, utilizing maternal serum, algorithm reported as a risk score","code_information":[ { "code": "81509", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative","code_information":[ { "code": "82731", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative","code_information":[ { "code": "85379", "type": "CPT" } ],"standard_charges":[{"minimum":42.2200,"maximum":42.2200,"gross_charge":42.2200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative or semiquantitative","code_information":[ { "code": "85378", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrin Degradation Products; agglutination slide, semiquantitative","code_information":[ { "code": "85362", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fibrinogen; activity","code_information":[ { "code": "85384", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"FMR1 gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81243", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"FOB Trans Needle Aspiration","code_information":[ { "code": "31639", "type": "CPT" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"fee schedule"}]}]},{"description":"Folic acid; serum","code_information":[ { "code": "82746", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Free T4 Free Thyroxine","code_information":[ { "code": "84439", "type": "CPT" } ],"standard_charges":[{"minimum":77.0000,"maximum":13.4100,"gross_charge":77.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma, thawing, each unit","code_information":[ { "code": "86927", "type": "CPT" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Fullthickness graft free incluiding direct closure of donor site; trunk; 20 sq cm or less","code_information":[ { "code": "15200", "type": "CPT" } ],"standard_charges":[{"minimum":929.9600,"maximum":929.9600,"gross_charge":929.9600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"fee schedule"}]}]},{"description":"Gabapentin, whole blood, serum or plasma","code_information":[ { "code": "80171", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Galactose 1 Phosphate uridyl transferase; quantitative","code_information":[ { "code": "82775", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gammaglobulin; IgA, IgD, IgG, IgM, each","code_information":[ { "code": "82784", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"}]}]},{"description":"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO10","code_information":[ { "code": "82803", "type": "CPT" } ],"standard_charges":[{"minimum":52.0000,"maximum":18.4500,"gross_charge":52.0000,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrectomy, total; with esophagoenterostomy","code_information":[ { "code": "43620", "type": "CPT" } ],"standard_charges":[{"minimum":2717.8500,"maximum":2717.8500,"gross_charge":2717.8500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"fee schedule"}]}]},{"description":"Gastrointestinal Pathogen; includes multiplex reserve transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets","code_information":[ { "code": "87507", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy, open; without construction of gastric tube","code_information":[ { "code": "43830", "type": "CPT" } ],"standard_charges":[{"minimum":971.6400,"maximum":971.6400,"gross_charge":971.6400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"fee schedule"}]}]},{"description":"Gastrotomy, with exploration or foreign body removal","code_information":[ { "code": "43500", "type": "CPT" } ],"standard_charges":[{"minimum":1103.3800,"maximum":1103.3800,"gross_charge":1103.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"fee schedule"}]}]},{"description":"Gentamicin","code_information":[ { "code": "80170", "type": "CPT" } ],"standard_charges":[{"minimum":36.4000,"maximum":36.4000,"gross_charge":36.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"fee schedule"}]}]},{"description":"Gliadin antibody, each immunoglobulin Ig class","code_information":[ { "code": "86258", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glucagon","code_information":[ { "code": "82943", "type": "CPT" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose","code_information":[ { "code": "82947", "type": "CPT" } ],"standard_charges":[{"minimum":48.0100,"maximum":5.8400,"gross_charge":48.0100,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose Body Fluid","code_information":[ { "code": "82945", "type": "CPT" } ],"standard_charges":[{"minimum":23.8000,"maximum":5.8400,"gross_charge":23.8000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"}]}]},{"description":"Glucose Tolerance test (GTT), 3 specimens (including glucose)","code_information":[ { "code": "82951", "type": "CPT" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glucose-6-Phosphate Dehydrogen (G6PD); quantitative","code_information":[ { "code": "82955", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Glutamyltransferase, gamma","code_information":[ { "code": "82977", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Glycated protein","code_information":[ { "code": "82985", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin, chorionic (hCG); quantitative","code_information":[ { "code": "84702", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin, chorionic; Qualitative","code_information":[ { "code": "84703", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin; follicle stimulating hormone (FSH)","code_information":[ { "code": "83001", "type": "CPT" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin; luteinizing hormone (LH)","code_information":[ { "code": "83002", "type": "CPT" } ],"standard_charges":[{"minimum":30.5500,"maximum":30.5500,"gross_charge":30.5500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"fee schedule"}]}]},{"description":"Growth Hormone, human (HGH)","code_information":[ { "code": "83003", "type": "CPT" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"}]}]},{"description":"H. Pylori IgG Antibody","code_information":[ { "code": "86677", "type": "CPT" } ],"standard_charges":[{"minimum":120.5300,"maximum":21.5900,"gross_charge":120.5300,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"fee schedule"}]}]},{"description":"Haemophilus Influenza","code_information":[ { "code": "86684", "type": "CPT" } ],"standard_charges":[{"minimum":245.1400,"maximum":245.1400,"gross_charge":245.1400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"fee schedule"}]}]},{"description":"HCV Genotype PCR","code_information":[ { "code": "87902", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":382.8700,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Heart transplant, with or without recipient cardiectomy","code_information":[ { "code": "33945", "type": "CPT" } ],"standard_charges":[{"minimum":6535.4200,"maximum":6535.4200,"gross_charge":6535.4200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"fee schedule"}]}]},{"description":"Heavy Metals; qualitative, any number of analytes","code_information":[ { "code": "83015", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori stool","code_information":[ { "code": "87338", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope","code_information":[ { "code": "83013", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin Fractionation and quantitation; electrophoresis","code_information":[ { "code": "83020", "type": "CPT" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; glycosilated (A1C)","code_information":[ { "code": "83036", "type": "CPT" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; Methemoglobin, quantitative","code_information":[ { "code": "83050", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinin; auto, screen, each","code_information":[ { "code": "86940", "type": "CPT" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinins; Incubated","code_information":[ { "code": "86941", "type": "CPT" } ],"standard_charges":[{"minimum":89.5000,"maximum":89.5000,"gross_charge":89.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":89.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"Heparin assay","code_information":[ { "code": "85520", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatic function panel","code_information":[ { "code": "80076", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A Antibody","code_information":[ { "code": "86708", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A Antibody IgM antibody","code_information":[ { "code": "86709", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Core Antibody Total","code_information":[ { "code": "86704", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Surface antigen","code_information":[ { "code": "87340", "type": "CPT" } ],"standard_charges":[{"minimum":50.4000,"maximum":50.4000,"gross_charge":50.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Surface Antigen neutralization","code_information":[ { "code": "87341", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B Virus, quantification","code_information":[ { "code": "87517", "type": "CPT" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis BE Antibody","code_information":[ { "code": "86707", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis BE Antigen","code_information":[ { "code": "87350", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C Antibody","code_information":[ { "code": "86803", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C Quantification, includes reverse transcription when performed","code_information":[ { "code": "87522", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hepatitis Delta agent","code_information":[ { "code": "86692", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Herpes Simplex Virus; amplified probe technique","code_information":[ { "code": "87529", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"fee schedule"}]}]},{"description":"Herpes Simplex, non-specific type test","code_information":[ { "code": "86694", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Heterophile antibodies; screening","code_information":[ { "code": "86308", "type": "CPT" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":7.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"}]}]},{"description":"Histoplasma","code_information":[ { "code": "86698", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Histoplasma capsulatum","code_information":[ { "code": "87385", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1","code_information":[ { "code": "87390", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":33.6000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1 and 2 Antibody","code_information":[ { "code": "86703", "type": "CPT" } ],"standard_charges":[{"minimum":5.8200,"maximum":5.8200,"gross_charge":5.8200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"fee schedule"}]}]},{"description":"HIV 1 Antibody","code_information":[ { "code": "86701", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1 antigens, with HIV-1 and HIV2 Antibodies, single result","code_information":[ { "code": "87389", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV 1, quantification, includes reverse transcription when performed","code_information":[ { "code": "87536", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV-1, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87535", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HIV-1, reverse transcriptase and protease regions","code_information":[ { "code": "87901", "type": "CPT" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, low resolution assessment, HLA-A, -B, -C, -DRB1\/3\/4\/5, and -DQB1","code_information":[ { "code": "81370", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HLA Class I tiping, high resolution, complete, one allele or allele group, each","code_information":[ { "code": "81381", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HLA typing; A, B or C, single antigen","code_information":[ { "code": "86812", "type": "CPT" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"}]}]},{"description":"Homocysteine","code_information":[ { "code": "83090", "type": "CPT" } ],"standard_charges":[{"minimum":203.0000,"maximum":203.0000,"gross_charge":203.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"fee schedule"}]}]},{"description":"Hot or cold packs therapy - Cryotherapy Application","code_information":[ { "code": "97010", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":22.0000,"gross_charge":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"HTLV I","code_information":[ { "code": "86687", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HTLV or HIV antibody, confirmatory test","code_information":[ { "code": "86689", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"HTT gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81271", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Human Papillomavirus, High Risk types","code_information":[ { "code": "87624", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Human to human leukocyte antigens (HLA), solid phase assays; antibody identification by qualitative panel using complete HLA phenotypes, HLA class I","code_information":[ { "code": "86830", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxycorticosteroids, 17-","code_information":[ { "code": "83491", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxyindolacetic acid, 5-","code_information":[ { "code": "83497", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Hydroxyprogesterone, 17-d","code_information":[ { "code": "83498", "type": "CPT" } ],"standard_charges":[{"minimum":260.6200,"maximum":260.6200,"gross_charge":260.6200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"fee schedule"}]}]},{"description":"Hysteroscopy, surgical; with endometrial ablation","code_information":[ { "code": "58563", "type": "CPT" } ],"standard_charges":[{"minimum":342.5900,"maximum":342.5900,"gross_charge":342.5900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"fee schedule"}]}]},{"description":"ICD Biventricular - biventricular ICD a small device","code_information":[ { "code": "33249", "type": "CPT" } ],"standard_charges":[{"minimum":1230.7800,"maximum":1200.0000,"gross_charge":1230.7800,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"fee schedule"}]}]},{"description":"ICD Generator change out","code_information":[ { "code": "33263", "type": "CPT" } ],"standard_charges":[{"minimum":523.6300,"maximum":1200.0000,"gross_charge":523.6300,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":523.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":523.6300,"methodology":"fee schedule"}]}]},{"description":"ICV Filter Remove","code_information":[ { "code": "37193", "type": "CPT" } ],"standard_charges":[{"minimum":462.2900,"maximum":1200.0000,"gross_charge":462.2900,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":469.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":462.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":469.9700,"methodology":"fee schedule"}]}]},{"description":"Image-guided fluid collection drainage by catheter, peritoneal or retroperitoneal, percutaneous","code_information":[ { "code": "49406", "type": "CPT" } ],"standard_charges":[{"minimum":188.8000,"maximum":772.0000,"gross_charge":188.8000,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.8000,"methodology":"fee schedule"}]}]},{"description":"Image-guided fluid collection drainage by catheter, peritoneal or retroperitoneal, transvaginally or transrectal","code_information":[ { "code": "49407", "type": "CPT" } ],"standard_charges":[{"minimum":200.0700,"maximum":772.0000,"gross_charge":200.0700,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.0700,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method","code_information":[ { "code": "83516", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative, by radioimmunoassay","code_information":[ { "code": "83519", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","code_information":[ { "code": "83520", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunofixation electrophoresis; serum","code_information":[ { "code": "86334", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Immunoglobulin E (IgE)","code_information":[ { "code": "82785", "type": "CPT" } ],"standard_charges":[{"minimum":12.6000,"maximum":12.6000,"gross_charge":12.6000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage Forearm and\/or wrist - bursa","code_information":[ { "code": "25031", "type": "CPT" } ],"standard_charges":[{"minimum":530.2200,"maximum":530.2200,"gross_charge":530.2200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage leg or ankle deep abcess or hematoma","code_information":[ { "code": "27603", "type": "CPT" } ],"standard_charges":[{"minimum":551.8800,"maximum":551.8800,"gross_charge":551.8800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage of an upper arm or elbow area; deep abscess or hematoma","code_information":[ { "code": "23930", "type": "CPT" } ],"standard_charges":[{"minimum":304.7400,"maximum":304.7400,"gross_charge":304.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage of Hematoma, seroma or fluid collection","code_information":[ { "code": "10140", "type": "CPT" } ],"standard_charges":[{"minimum":164.0500,"maximum":164.0500,"gross_charge":164.0500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"fee schedule"}]}]},{"description":"Incision & Drainage, bursa, foot","code_information":[ { "code": "28001", "type": "CPT" } ],"standard_charges":[{"minimum":195.4300,"maximum":195.4300,"gross_charge":195.4300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of abcess; complicated or multiple","code_information":[ { "code": "10061", "type": "CPT" } ],"standard_charges":[{"minimum":259.7600,"maximum":259.7600,"gross_charge":259.7600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, complex, postoperative wound infection","code_information":[ { "code": "10180", "type": "CPT" } ],"standard_charges":[{"minimum":251.6100,"maximum":251.6100,"gross_charge":251.6100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, deep abcess or hematoma, soft tissues of neck or thorax","code_information":[ { "code": "21501", "type": "CPT" } ],"standard_charges":[{"minimum":478.7700,"maximum":478.7700,"gross_charge":478.7700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"fee schedule"}]}]},{"description":"Incision and removal of foreing body, subcutaneous tissues; complicated","code_information":[ { "code": "10121", "type": "CPT" } ],"standard_charges":[{"minimum":1200.0000,"maximum":1200.0000,"gross_charge":1200.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1200.0000,"methodology":"fee schedule"}]}]},{"description":"Incision and removal of foreing body, subcutaneous tissues; simple","code_information":[ { "code": "10120", "type": "CPT" } ],"standard_charges":[{"minimum":146.6900,"maximum":146.6900,"gross_charge":146.6900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1200.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed 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schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee 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schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed 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separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple 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Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infectius agent antigen detention by immunoassay with direct optical observation; not otherwise specified","code_information":[ { "code": "87899", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Infecttiuos agent phenotype analysis by nucleic acids, with drug resistance tissue culture analysis, HIV-1; first through 10 drugs tested","code_information":[ { "code": "87903", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza","code_information":[ { "code": "87804", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza A and B, each","code_information":[ { "code": "87400", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and mutiplex amplified probe technique, first 2 types or sub types","code_information":[ { "code": "87502", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Inhaler Therapy Delivery System","code_information":[ { "code": "94640", "type": "CPT" } ],"standard_charges":[{"minimum":22.2600,"maximum":22.2600,"gross_charge":22.2600,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.2600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Injection procedure for antegrade nephrostogram and\/or ureterogram, complete diagnostic procedure including imaging guidance, and all associated radiological supervision and interpretation; new access","code_information":[ { "code": "50430", "type": "CPT" } ],"standard_charges":[{"minimum":149.9100,"maximum":1428.0000,"gross_charge":149.9100,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9100,"methodology":"fee schedule"}]}]},{"description":"Injection procedure; lymphangiography","code_information":[ { "code": "38790", "type": "CPT" } ],"standard_charges":[{"minimum":115.4900,"maximum":115.4900,"gross_charge":115.4900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"fee schedule"}]}]},{"description":"Injection(s) of a sclerosing solution for the treatment of spider veins (telangiectasia) in the limbs or trunk","code_information":[ { "code": "36468", "type": "CPT" } ],"standard_charges":[{"minimum":37.2400,"maximum":2205.0000,"gross_charge":37.2400,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2400,"methodology":"fee schedule"}]}]},{"description":"Injection, dipyridamole, per 10 mg","code_information":[ { "code": "J1245", "type": "CPT" } ],"standard_charges":[{"minimum":30.8000,"maximum":30.8000,"gross_charge":30.8000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"}]}]},{"description":"Inpatient Consult","code_information":[ { "code": "99255", "type": "CPT" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"outpatient","payers_information":[{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Insertion Atrial ICD Lead","code_information":[ { "code": "33216", "type": "CPT" } ],"standard_charges":[{"minimum":503.6100,"maximum":1200.0000,"gross_charge":503.6100,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"fee schedule"}]}]},{"description":"Insertion Catheter","code_information":[ { "code": "36569", "type": "CPT" } ],"standard_charges":[{"minimum":127.8500,"maximum":1200.0000,"gross_charge":127.8500,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.8500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.8500,"methodology":"fee schedule"}]}]},{"description":"Insertion of a cannula for hemodialysis, other purpose (separe procedure); vein-to-vein","code_information":[ { "code": "36800", "type": "CPT" } ],"standard_charges":[{"minimum":163.2300,"maximum":163.2300,"gross_charge":163.2300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"fee schedule"}]}]},{"description":"Insertion of a non-tunneled centrally inserted central venous catheter; younger than 5 years of age","code_information":[ { "code": "36556", "type": "CPT" } ],"standard_charges":[{"minimum":116.0200,"maximum":116.0200,"gross_charge":116.0200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"fee schedule"}]}]},{"description":"Insertion of a peripherally inserted central venous access device, with subcutaneous port; younger than five years of age","code_information":[ { "code": "36570", "type": "CPT" } ],"standard_charges":[{"minimum":464.2100,"maximum":464.2100,"gross_charge":464.2100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"fee schedule"}]}]},{"description":"Insertion of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than five years of age","code_information":[ { "code": "36572", "type": "CPT" } ],"standard_charges":[{"minimum":110.8200,"maximum":1200.0000,"gross_charge":110.8200,"setting":"both","payers_information":[{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.8200,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous access device with a subcutaneous pump","code_information":[ { "code": "36563", "type": "CPT" } ],"standard_charges":[{"minimum":499.6900,"maximum":499.6900,"gross_charge":499.6900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous access device, with subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36560", "type": "CPT" } ],"standard_charges":[{"minimum":534.4900,"maximum":534.4900,"gross_charge":534.4900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"fee schedule"}]}]},{"description":"Insertion of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36557", "type": "CPT" } ],"standard_charges":[{"minimum":440.1600,"maximum":440.1600,"gross_charge":440.1600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"fee schedule"}]}]},{"description":"Insertion of an intra-aortic balloon assist device, percutaneous","code_information":[ { "code": "33967", "type": "CPT" } ],"standard_charges":[{"minimum":346.6300,"maximum":346.6300,"gross_charge":346.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"fee schedule"}]}]},{"description":"Insertion of epicardial electrode; endoscopic approach","code_information":[ { "code": "33203", "type": "CPT" } ],"standard_charges":[{"minimum":1116.2900,"maximum":1116.2900,"gross_charge":1116.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"fee schedule"}]}]},{"description":"Insertion of epicardial electrode; open incision","code_information":[ { "code": "33202", "type": "CPT" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of indwelling tunneled pleural catheter with cuff","code_information":[ { "code": "32550", "type": "CPT" } ],"standard_charges":[{"minimum":275.1000,"maximum":275.1000,"gross_charge":275.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radilogical supervision and interpretation, intraprocedural roadmapping, and imaging guidance, when perfomed","code_information":[ { "code": "37191", "type": "CPT" } ],"standard_charges":[{"minimum":299.1000,"maximum":299.1000,"gross_charge":299.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"fee schedule"}]}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; atrial and ventricular","code_information":[ { "code": "33208", "type": "CPT" } ],"standard_charges":[{"minimum":710.6400,"maximum":710.6400,"gross_charge":710.6400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"fee schedule"}]}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; ventricular","code_information":[ { "code": "33207", "type": "CPT" } ],"standard_charges":[{"minimum":645.9000,"maximum":645.9000,"gross_charge":645.9000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacemaker pulse generator only; with existing single lead","code_information":[ { "code": "33212", "type": "CPT" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator","code_information":[ { "code": "33225", "type": "CPT" } ],"standard_charges":[{"minimum":629.0900,"maximum":629.0900,"gross_charge":629.0900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator","code_information":[ { "code": "33224", "type": "CPT" } ],"standard_charges":[{"minimum":698.1200,"maximum":698.1200,"gross_charge":698.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of temporary transvenous single chaber cardiac electrode or pacemaker catheter","code_information":[ { "code": "33210", "type": "CPT" } ],"standard_charges":[{"minimum":219.7700,"maximum":219.7700,"gross_charge":219.7700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"fee schedule"}]}]},{"description":"Insertion, subcutaneous cardiac rhythm monitor, including programming","code_information":[ { "code": "33285", "type": "CPT" } ],"standard_charges":[{"minimum":800.0000,"maximum":800.0000,"gross_charge":800.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"fee schedule"}]}]},{"description":"Instillation, via chest tube\/catheter, agent for pleurodesis","code_information":[ { "code": "32560", "type": "CPT" } ],"standard_charges":[{"minimum":926.8700,"maximum":772.0000,"gross_charge":926.8700,"setting":"both","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"fee schedule"}]}]},{"description":"Insulin antibodies","code_information":[ { "code": "86337", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Insulin Level Total","code_information":[ { "code": "83525", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Insulin like Growth Factor I","code_information":[ { "code": "84305", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":31.6200,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":189.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Interleukin-6 (IL-6)","code_information":[ { "code": "83529", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Intra cardiac catheter ablation of artrioventricular node function, atrion ventricular condution for creation of complete heart block, with or without temporary pacemaker placement","code_information":[ { "code": "93650", "type": "CPT" } ],"standard_charges":[{"minimum":791.7400,"maximum":791.7400,"gross_charge":791.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"fee schedule"}]}]},{"description":"Intra-atrial pacing","code_information":[ { "code": "93610", "type": "CPT" } ],"standard_charges":[{"minimum":4712.9300,"maximum":4712.9300,"gross_charge":4712.9300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":4712.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":4712.9300,"methodology":"fee schedule"}]}]},{"description":"Intracardiac electrophysiology 3 dimensional mapping","code_information":[ { "code": "93613", "type": "CPT" } ],"standard_charges":[{"minimum":390.2400,"maximum":390.2400,"gross_charge":390.2400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First 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S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"fee schedule"}]}]},{"description":"Intravascular ultrasound during diagnostic evaluation and\/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel","code_information":[ { "code": "37253", "type": "CPT" } ],"standard_charges":[{"minimum":95.8900,"maximum":95.8900,"gross_charge":95.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"fee 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schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":82.8900,"methodology":"fee 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schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":82.8900,"methodology":"fee 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schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S 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Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":82.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":82.8900,"methodology":"fee schedule"}]}]},{"description":"Invasive Radiology Abscess Diagnostic: All inclusive, except physician's professional fees","code_information":[ { "code": "77001", "type": "CPT" } ],"standard_charges":[{"minimum":1080.0000,"maximum":1080.0000,"gross_charge":1080.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1080.0000,"methodology":"fee schedule"}]}]},{"description":"Iron","code_information":[ { "code": "83540", "type": "CPT" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Iron Binding Capacity","code_information":[ { "code": "83550", "type": "CPT" } ],"standard_charges":[{"minimum":18.0000,"maximum":18.0000,"gross_charge":18.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"fee schedule"}]}]},{"description":"Irradiation of blood product, each unit","code_information":[ { "code": "86945", "type": "CPT" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"fee schedule"}]}]},{"description":"Islet cell antibody","code_information":[ { "code": "86341", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"John Cunningham virus Antibody","code_information":[ { "code": "86711", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ketones body(s); qualitative","code_information":[ { "code": "82009", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Ketosteroids, 17- (17-KS); total","code_information":[ { "code": "83586", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Lactate","code_information":[ { "code": "83605", "type": "CPT" } ],"standard_charges":[{"minimum":76.0000,"maximum":76.0000,"gross_charge":76.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"fee schedule"}]}]},{"description":"Lactate Dehydrogenase (LD), (LDH)","code_information":[ { "code": "83615", "type": "CPT" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Lamotrigine","code_information":[ { "code": "80175", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Laparoscopic, abdomen, peritoneum, and omentum, diagnostic, with or without specimen collection of specimen(s) by brushing or washing","code_information":[ { "code": "49320", "type": "CPT" } 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Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":3673.8700,"methodology":"fee schedule"}]}]},{"description":"Valvuloplasty, tricuspid valve; with ring insertion","code_information":[ { "code": "33464", "type": "CPT" } ],"standard_charges":[{"minimum":3280.3800,"maximum":3280.3800,"gross_charge":3280.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"fee schedule"}]}]},{"description":"Valvuloplasty, tricuspid valve; without ring insertion","code_information":[ { "code": "33463", "type": "CPT" } ],"standard_charges":[{"minimum":4134.6500,"maximum":4134.6500,"gross_charge":4134.6500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"fee schedule"}]}]},{"description":"Vancomycin","code_information":[ { "code": "80202", "type": "CPT" } ],"standard_charges":[{"minimum":61.0000,"maximum":61.0000,"gross_charge":61.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"fee schedule"}]}]},{"description":"Vanillymandelic acid urine","code_information":[ { "code": "84585", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Varicella zoster","code_information":[ { "code": "86787", "type": "CPT" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"fee schedule"}]}]},{"description":"Varicella Zoster Direct FA","code_information":[ { "code": "87290", "type": "CPT" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor","code_information":[ { "code": "37242", "type": "CPT" } ],"standard_charges":[{"minimum":460.3600,"maximum":1428.0000,"gross_charge":460.3600,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":460.3600,"methodology":"fee schedule"}]}]},{"description":"Venipuncture, cuntdown; age 1 or over","code_information":[ { "code": "36425", "type": "CPT" } ],"standard_charges":[{"minimum":53.6300,"maximum":53.6300,"gross_charge":53.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"fee schedule"}]}]},{"description":"Venography- caval, inferior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75825", "type": "CPT" } ],"standard_charges":[{"minimum":157.3300,"maximum":157.3300,"gross_charge":157.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"fee schedule"}]}]},{"description":"Venography- caval, superior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75827", "type": "CPT" } ],"standard_charges":[{"minimum":163.8100,"maximum":163.8100,"gross_charge":163.8100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S 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],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare 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be billed separately","standard_charge_dollar":1897.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1897.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transferase Aspartate Amino","code_information":[ { "code": "84450", "type": "DRG" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"1 Red Blood Cell Ag Neg\/Unit: 86902","code_information":[ { "code": "86902", "type": "DRG" } ],"standard_charges":[{"minimum":97.0000,"maximum":97.0000,"gross_charge":97.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"12 mm & Stapler Bladeless Obturator","code_information":[ { "code": "3021135", "type": "DRG" } ],"standard_charges":[{"minimum":1205.4000,"maximum":1205.4000,"gross_charge":1205.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"12 mm & Stapler Cannula, Long","code_information":[ { "code": "3021136", "type": "DRG" } ],"standard_charges":[{"minimum":1911.0000,"maximum":1911.0000,"gross_charge":1911.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"12-8 mm Reducer","code_information":[ { "code": "3021133", "type": "DRG" } ],"standard_charges":[{"minimum":36.8700,"maximum":36.8700,"gross_charge":36.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"2 Basin Set with Graduated PK","code_information":[ { "code": "270000093", "type": "DRG" } ],"standard_charges":[{"minimum":82.2100,"maximum":82.2100,"gross_charge":82.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"3 Way Stop Cock w\/Swivel Male Luer","code_information":[ { "code": "270000095", "type": "DRG" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation","code_information":[ { "code": "76376", "type": "DRG" } ],"standard_charges":[{"minimum":34.3300,"maximum":34.3300,"gross_charge":34.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation","code_information":[ { "code": "76377", "type": "DRG" } ],"standard_charges":[{"minimum":108.1900,"maximum":108.1900,"gross_charge":108.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":108.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":109.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"5071-35 cm Sutureless, unipolar,","code_information":[ { "code": "2711235", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"5833SL Disposable Surgical Cable. One","code_information":[ { "code": "270000001", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"7-Band Ligator (Speed Band Superview","code_information":[ { "code": "2810764", "type": "DRG" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"8 Foot Disposable Extension Cable with","code_information":[ { "code": "270000003", "type": "DRG" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"8 mm Bladeless Obturator","code_information":[ { "code": "3021122", "type": "DRG" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"8 mm Bladeless Obturator, Long","code_information":[ { "code": "3021123", "type": "DRG" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"8 mm Instrument Cannula","code_information":[ { "code": "3021124", "type": "DRG" } ],"standard_charges":[{"minimum":882.0000,"maximum":882.0000,"gross_charge":882.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"8 mm Instrument Cannula, Long","code_information":[ { "code": "3021125", "type": "DRG" } ],"standard_charges":[{"minimum":956.2000,"maximum":956.2000,"gross_charge":956.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021085", "type": "DRG" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021086", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5880.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021074", "type": "DRG" } ],"standard_charges":[{"minimum":10500.0000,"maximum":10500.0000,"gross_charge":10500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021076", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":10500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021339", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":10500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ablation therapy for reduction or eradication of 1 or more pulmonary tumor incluiding pleural or chest wall ehen involved by rumor extension, percutaneous, incluiding imaging guidance when performed, unilateral; Cryoablation","code_information":[ { "code": "32994", "type": "DRG" } ],"standard_charges":[{"minimum":595.2100,"maximum":595.2100,"gross_charge":595.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Accolade MRI DR L311","code_information":[ { "code": "2820784", "type": "DRG" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Accolade MRI SR L310","code_information":[ { "code": "3017204", "type": "DRG" } ],"standard_charges":[{"minimum":1881.6000,"maximum":1881.6000,"gross_charge":1881.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acetaminophen","code_information":[ { "code": "80143", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acetylcholine Receptor; binding antibody","code_information":[ { "code": "86041", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Actin, antibody (ASMA), each","code_information":[ { "code": "86015", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Mailman Straigth Tip Veus","code_information":[ { "code": "270000005", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Amplatz(A6)","code_information":[ { "code": "270000101", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000103", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000105", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000107", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000109", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Multipurpose","code_information":[ { "code": "270000111", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Pro Coronary Sinus Wide(W)","code_information":[ { "code": "270000113", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Spiral 4592 90CM","code_information":[ { "code": "2820792", "type": "DRG" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Universal Cutter (Model 7060)","code_information":[ { "code": "270000115", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Whisper View DS CS-J Guide Wire","code_information":[ { "code": "270000117", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Whisper View DS Straight Tip","code_information":[ { "code": "270000119", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Whisper View EDS CS-J Guide","code_information":[ { "code": "270000007", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity Whisper View ES Straight Tip","code_information":[ { "code": "270000121", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acuity X4 Straight 4671 86CM","code_information":[ { "code": "3017469", "type": "DRG" } ],"standard_charges":[{"minimum":1478.4000,"maximum":1478.4000,"gross_charge":1478.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acusnare Polypectomy Snare 3 cm x 6 cm","code_information":[ { "code": "270001119", "type": "DRG" } ],"standard_charges":[{"minimum":448.0000,"maximum":448.0000,"gross_charge":448.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acute Dual Lumen Catheter Kit 4.5mm x","code_information":[ { "code": "270000123", "type": "DRG" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acute Hepatitis Panel","code_information":[ { "code": "80074", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Acylcarnitines; qualitative, each specimen","code_information":[ { "code": "82016", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adapta ADDR03","code_information":[ { "code": "2740034", "type": "DRG" } ],"standard_charges":[{"minimum":4543.0000,"maximum":4543.0000,"gross_charge":4543.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adjustable Slitter 6232ADJ","code_information":[ { "code": "270000009", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adrenalectomy, partial or complete; with excision of adjacent retroperitoneal tumor","code_information":[ { "code": "60545", "type": "DRG" } ],"standard_charges":[{"minimum":1719.4200,"maximum":1719.4200,"gross_charge":1719.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1719.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adrenalectomy, partial or complete; with out radical mediastinal dissection","code_information":[ { "code": "60521", "type": "DRG" } ],"standard_charges":[{"minimum":1531.7800,"maximum":1531.7800,"gross_charge":1531.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1531.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adrenocorticotropic Hormone","code_information":[ { "code": "82024", "type": "DRG" } ],"standard_charges":[{"minimum":72.1000,"maximum":72.1000,"gross_charge":72.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adult Filter","code_information":[ { "code": "2720168", "type": "DRG" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Adult Hemo Concentrator","code_information":[ { "code": "3020683", "type": "DRG" } ],"standard_charges":[{"minimum":145.8400,"maximum":145.8400,"gross_charge":145.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"After Hour Panel - Fee for weekends and holidays","code_information":[ { "code": "99051", "type": "DRG" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ag Screening spec order 1-10","code_information":[ { "code": "G0103", "type": "DRG" } ],"standard_charges":[{"minimum":59.0000,"maximum":59.0000,"gross_charge":59.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ag Screening spec order 11-20","code_information":[ { "code": "G0102", "type": "DRG" } ],"standard_charges":[{"minimum":116.5000,"maximum":116.5000,"gross_charge":116.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ag type per donor Red Blood Cells (RBC) per anligen","code_information":[ { "code": "86904", "type": "DRG" } ],"standard_charges":[{"minimum":92.5000,"maximum":92.5000,"gross_charge":92.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AICD Lead Stylet (Model 6828)","code_information":[ { "code": "270000129", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AICD Lead Stylets (Model 6972)","code_information":[ { "code": "270000131", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Albumin; , urine, semiquantitative","code_information":[ { "code": "82043", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Albumin; other source, quantitative, each specimen","code_information":[ { "code": "82042", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Albumin; serum, plasma or whole blood","code_information":[ { "code": "82040", "type": "DRG" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Albuterol Sulfate Inhalation Aerosol","code_information":[ { "code": "250000075", "type": "DRG" } ],"standard_charges":[{"minimum":266.1000,"maximum":266.1000,"gross_charge":266.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alcohol; breath","code_information":[ { "code": "82075", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alcohols","code_information":[ { "code": "80320", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aldosterone","code_information":[ { "code": "82088", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alexis Wound Protector\/Retractor XS","code_information":[ { "code": "2790934", "type": "DRG" } ],"standard_charges":[{"minimum":75.6000,"maximum":75.6000,"gross_charge":75.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alkaloids, not otherwise specified","code_information":[ { "code": "80323", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Allergen Specific IgE; quantitative or semi quantitative, crude allergen extract, each","code_information":[ { "code": "86003", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Allure CRT-P Quadripolar","code_information":[ { "code": "8017738", "type": "DRG" } ],"standard_charges":[{"minimum":2612.4000,"maximum":2612.4000,"gross_charge":2612.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alpha 1 Antitrypsin total","code_information":[ { "code": "82103", "type": "DRG" } ],"standard_charges":[{"minimum":35.2000,"maximum":35.2000,"gross_charge":35.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Alpha Fetoprotein (AFP); serum","code_information":[ { "code": "82105", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aluminum","code_information":[ { "code": "82108", "type": "DRG" } ],"standard_charges":[{"minimum":87.3600,"maximum":87.3600,"gross_charge":87.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amikacin Peak","code_information":[ { "code": "80150", "type": "DRG" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amino acids, 6 or more amino acids, quantitative, each specimen","code_information":[ { "code": "82139", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AMINOPHYLLINE 250MG VIAL","code_information":[ { "code": "J0280", "type": "DRG" } ],"standard_charges":[{"minimum":18.5800,"maximum":18.5800,"gross_charge":18.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ammonia","code_information":[ { "code": "82140", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amphetamine","code_information":[ { "code": "80324", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Piccolo Occluder Duct","code_information":[ { "code": "3019766", "type": "DRG" } ],"standard_charges":[{"minimum":11900.0000,"maximum":11900.0000,"gross_charge":11900.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3010991", "type": "DRG" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3011012", "type": "DRG" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Duct Occluder 12mm\/10mm\/8mm","code_information":[ { "code": "2780732", "type": "DRG" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Guidewire 260cm\/1.5mm Abbott","code_information":[ { "code": "2780726", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Multifenestrated Septal","code_information":[ { "code": "2780736", "type": "DRG" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Muscular VSD Occluder","code_information":[ { "code": "2780735", "type": "DRG" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer PFO Occluder 18mm Abbott","code_information":[ { "code": "3017640", "type": "DRG" } ],"standard_charges":[{"minimum":7560.0000,"maximum":7560.0000,"gross_charge":7560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Septal Occluder 10mm Abbott","code_information":[ { "code": "2780729", "type": "DRG" } ],"standard_charges":[{"minimum":6650.0000,"maximum":6650.0000,"gross_charge":6650.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Sizing Balloon II 18mm\/70cm","code_information":[ { "code": "270000135", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Sizing Balloon II 24mm\/70cm","code_information":[ { "code": "270000137", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Sizing Balloon II 34mm\/70cm","code_information":[ { "code": "270000139", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Talisman 45 Delivery System","code_information":[ { "code": "270000141", "type": "DRG" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Talisman Delivery Sheath 9F","code_information":[ { "code": "270000143", "type": "DRG" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Talisman PFO Occluder","code_information":[ { "code": "3020851", "type": "DRG" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000145", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000147", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue 45 Delivery System","code_information":[ { "code": "270000149", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue 45x45 14F\/80cm","code_information":[ { "code": "270000151", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue 45x45 Delivery","code_information":[ { "code": "270000153", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000155", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000157", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000159", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000161", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000163", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000165", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000167", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000169", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000171", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amputation Foot; midtarsal","code_information":[ { "code": "28800", "type": "DRG" } ],"standard_charges":[{"minimum":729.1100,"maximum":729.1100,"gross_charge":729.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":729.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amputation metatarsal with toe single","code_information":[ { "code": "28810", "type": "DRG" } ],"standard_charges":[{"minimum":584.8500,"maximum":584.8500,"gross_charge":584.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":584.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amputation, forearm, through radius and ulna","code_information":[ { "code": "25900", "type": "DRG" } ],"standard_charges":[{"minimum":1002.4700,"maximum":1002.4700,"gross_charge":1002.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amputation, leg, through tibia and fibula","code_information":[ { "code": "27880", "type": "DRG" } ],"standard_charges":[{"minimum":1229.8900,"maximum":1229.8900,"gross_charge":1229.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1229.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amputation, thigh, through femur, any level","code_information":[ { "code": "27590", "type": "DRG" } ],"standard_charges":[{"minimum":1073.9800,"maximum":1073.9800,"gross_charge":1073.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Amylase","code_information":[ { "code": "82150", "type": "DRG" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Androstenedione","code_information":[ { "code": "82157", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter 4F\/100cm\/.38\"","code_information":[ { "code": "270000177", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter 4F\/65cm\/.035\"","code_information":[ { "code": "270000179", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter 5F\/100cm\/.38\"","code_information":[ { "code": "270000181", "type": "DRG" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter 5F\/65cm\/PIGTAIL","code_information":[ { "code": "270000183", "type": "DRG" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter Extension 100cm","code_information":[ { "code": "270000185", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter Extension 65cm","code_information":[ { "code": "270000187", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheter UF 5F\/65cm\/.035\"","code_information":[ { "code": "270000189", "type": "DRG" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiographic Catheters","code_information":[ { "code": "270000191", "type": "DRG" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography Adrenal bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75733", "type": "DRG" } ],"standard_charges":[{"minimum":238.1500,"maximum":238.1500,"gross_charge":238.1500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography Adrenal unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75731", "type": "DRG" } ],"standard_charges":[{"minimum":211.8800,"maximum":211.8800,"gross_charge":211.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography Extremity Bilateral radiological supervision and interpretation","code_information":[ { "code": "75716", "type": "DRG" } ],"standard_charges":[{"minimum":224.3800,"maximum":224.3800,"gross_charge":224.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography Extremity. Unilateral radiological supervision and interpretation","code_information":[ { "code": "75710", "type": "DRG" } ],"standard_charges":[{"minimum":206.8800,"maximum":206.8800,"gross_charge":206.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":206.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography pelvic, selective or supraselective, radiological supervision and interpretation","code_information":[ { "code": "75736", "type": "DRG" } ],"standard_charges":[{"minimum":198.0000,"maximum":198.0000,"gross_charge":198.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography spinal selective radiological supervision and interpretation","code_information":[ { "code": "75705", "type": "DRG" } ],"standard_charges":[{"minimum":345.4500,"maximum":345.4500,"gross_charge":345.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography visceral, selective or suoraselective, radiological supervision and interpretation","code_information":[ { "code": "75726", "type": "DRG" } ],"standard_charges":[{"minimum":234.1200,"maximum":234.1200,"gross_charge":234.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75743", "type": "DRG" } ],"standard_charges":[{"minimum":203.3500,"maximum":203.3500,"gross_charge":203.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography, pulmonary, by nonselective catheter or venous injection radiological supervision and interpretation","code_information":[ { "code": "75746", "type": "DRG" } ],"standard_charges":[{"minimum":186.0300,"maximum":186.0300,"gross_charge":186.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation","code_information":[ { "code": "75741", "type": "DRG" } ],"standard_charges":[{"minimum":179.0300,"maximum":179.0300,"gross_charge":179.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angio-Seal Vascular Closure Device 6F","code_information":[ { "code": "2780198", "type": "DRG" } ],"standard_charges":[{"minimum":245.0000,"maximum":245.0000,"gross_charge":245.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angiotensin I - converting enzyme (ACE)","code_information":[ { "code": "82164", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Angio-Touch Kit AT X65","code_information":[ { "code": "270000193", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Anti Phospholipid Antibody","code_information":[ { "code": "86148", "type": "DRG" } ],"standard_charges":[{"minimum":331.8000,"maximum":331.8000,"gross_charge":331.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":331.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antibody elution (RBC) each","code_information":[ { "code": "86860", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antibody identification, RBC antibodies, each panel for each serum technique","code_information":[ { "code": "86870", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antibody screen, RBC, each serum technique","code_information":[ { "code": "86850", "type": "DRG" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antibody; Influenza Virus","code_information":[ { "code": "86710", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antidepressants, tricyclic and other cyclicals; 6 or more","code_information":[ { "code": "80337", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antihuman globulin test (Coombs test); direct, each antiserum","code_information":[ { "code": "86880", "type": "DRG" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antihuman globulin test; Indirect, each antibody titer","code_information":[ { "code": "86886", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antihuman globulin test; Indirect, qualitative, each reagent","code_information":[ { "code": "86885", "type": "DRG" } ],"standard_charges":[{"minimum":17.5000,"maximum":17.5000,"gross_charge":17.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AntiNeutrophil Cytoplasmic Antibody; screen each antibody","code_information":[ { "code": "86036", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AntiNuclear Antibodies Titer","code_information":[ { "code": "86039", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AntiNuclear Antibodies;","code_information":[ { "code": "86038", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antistreptolysin O Screen","code_information":[ { "code": "86063", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Antistreptolysin O Titer","code_information":[ { "code": "86060", "type": "DRG" } ],"standard_charges":[{"minimum":10.0100,"maximum":10.0100,"gross_charge":10.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aorta Punch 4.0","code_information":[ { "code": "270001123", "type": "DRG" } ],"standard_charges":[{"minimum":52.2800,"maximum":52.2800,"gross_charge":52.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortic Balloon 10Fr x 120 cm x 0.038\"","code_information":[ { "code": "2704965", "type": "DRG" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortic Canula Adult","code_information":[ { "code": "2702320", "type": "DRG" } ],"standard_charges":[{"minimum":51.1000,"maximum":51.1000,"gross_charge":51.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortic FlexCuff Rotatable Mechanical","code_information":[ { "code": "2703875", "type": "DRG" } ],"standard_charges":[{"minimum":5726.0000,"maximum":5726.0000,"gross_charge":5726.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortic Regent Flex W\/O Silicone Model:","code_information":[ { "code": "2790177", "type": "DRG" } ],"standard_charges":[{"minimum":5425.0000,"maximum":5425.0000,"gross_charge":5425.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aorto Punch 4.5","code_information":[ { "code": "270001125", "type": "DRG" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aorto Punch 4.8","code_information":[ { "code": "2700051", "type": "DRG" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortography Abdominal by Serialography radiological supervision and interpretation","code_information":[ { "code": "75625", "type": "DRG" } ],"standard_charges":[{"minimum":177.1300,"maximum":177.1300,"gross_charge":177.1300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":174.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortography abdominal plus bilateral iliofemoral lower extremity, catheter by seriolography, radiological supervision and interpretation","code_information":[ { "code": "75630", "type": "DRG" } ],"standard_charges":[{"minimum":219.6500,"maximum":219.6500,"gross_charge":219.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortography Thoracic by Serialography radiological supervision and interpretation","code_information":[ { "code": "75605", "type": "DRG" } ],"standard_charges":[{"minimum":166.6000,"maximum":166.6000,"gross_charge":166.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aortography Thoracic Without Serialography radiological supervision and interpretation","code_information":[ { "code": "75600", "type": "DRG" } ],"standard_charges":[{"minimum":252.2500,"maximum":252.2500,"gross_charge":252.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Apheresis Imported from US","code_information":[ { "code": "EU102", "type": "DRG" } ],"standard_charges":[{"minimum":750.0000,"maximum":750.0000,"gross_charge":750.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Apolipoprotein, each","code_information":[ { "code": "82172", "type": "DRG" } ],"standard_charges":[{"minimum":29.1200,"maximum":29.1200,"gross_charge":29.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Appendectomy","code_information":[ { "code": "44950", "type": "DRG" } ],"standard_charges":[{"minimum":885.4700,"maximum":885.4700,"gross_charge":885.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":885.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20690", "type": "DRG" } ],"standard_charges":[{"minimum":827.9900,"maximum":827.9900,"gross_charge":827.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":827.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Application of a multiplane (pins in more than one plane), unilateral, external fixation system","code_information":[ { "code": "20692", "type": "DRG" } ],"standard_charges":[{"minimum":1591.1400,"maximum":1591.1400,"gross_charge":827.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1591.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Appose ULC Slim Body Skin Stapler 35","code_information":[ { "code": "3021163", "type": "DRG" } ],"standard_charges":[{"minimum":504.0000,"maximum":504.0000,"gross_charge":504.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Argyle Latex Penrose Tubbing 38 mm x","code_information":[ { "code": "270001127", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arterio-Carotid,Cereb, Unill","code_information":[ { "code": "75665", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arterio-Carotid,Cerebral, Bil","code_information":[ { "code": "75671", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arterio-Carotid,Cerv, Unil","code_information":[ { "code": "75676", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arterio-Carotid,Cervical, Bil","code_information":[ { "code": "75680", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition","code_information":[ { "code": "36818", "type": "DRG" } ],"standard_charges":[{"minimum":927.7800,"maximum":927.7800,"gross_charge":927.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)","code_information":[ { "code": "36821", "type": "DRG" } ],"standard_charges":[{"minimum":887.9200,"maximum":887.9200,"gross_charge":887.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arterio-Vertebral, Angio UNI","code_information":[ { "code": "75685", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints) surgical; with removal of loose body or foreing body","code_information":[ { "code": "29894", "type": "DRG" } ],"standard_charges":[{"minimum":702.5600,"maximum":702.5600,"gross_charge":702.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arthroscopy, hip, diagnostic with or without synovial biopsy","code_information":[ { "code": "29860", "type": "DRG" } ],"standard_charges":[{"minimum":914.6600,"maximum":914.6600,"gross_charge":914.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":914.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arthroscopy, knee, diagnostic with or without synovial biopsy","code_information":[ { "code": "29870", "type": "DRG" } ],"standard_charges":[{"minimum":576.0300,"maximum":576.0300,"gross_charge":576.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":576.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arthroscopy, shoulder, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29805", "type": "DRG" } ],"standard_charges":[{"minimum":654.9900,"maximum":654.9900,"gross_charge":654.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":654.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy","code_information":[ { "code": "29840", "type": "DRG" } ],"standard_charges":[{"minimum":632.6300,"maximum":632.6300,"gross_charge":632.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":632.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)","code_information":[ { "code": "33859", "type": "DRG" } ],"standard_charges":[{"minimum":3273.3100,"maximum":3273.3100,"gross_charge":3273.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3273.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass includes valve suspension, when performed; for aortic dissection","code_information":[ { "code": "33858", "type": "DRG" } ],"standard_charges":[{"minimum":4553.1100,"maximum":4553.1100,"gross_charge":4553.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4553.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ASPA gene analysis, common variants","code_information":[ { "code": "81200", "type": "DRG" } ],"standard_charges":[{"minimum":582.4000,"maximum":582.4000,"gross_charge":582.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Aspergillus","code_information":[ { "code": "86606", "type": "DRG" } ],"standard_charges":[{"minimum":53.0000,"maximum":53.0000,"gross_charge":53.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Assurity MRI DR Pulse Generator PM2272","code_information":[ { "code": "2820766", "type": "DRG" } ],"standard_charges":[{"minimum":3129.0000,"maximum":3129.0000,"gross_charge":3129.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Atrial septectomy or septostomy; open heart cardiopulmonary bypass","code_information":[ { "code": "33736", "type": "DRG" } ],"standard_charges":[{"minimum":1909.8400,"maximum":1909.8400,"gross_charge":1909.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1909.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure cryoICE\/Cryoablation Probe 10","code_information":[ { "code": "3020712", "type": "DRG" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure cryoICE\/cryoSPHERE 18''","code_information":[ { "code": "270000201", "type": "DRG" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure Isolator SYNERGY","code_information":[ { "code": "3020711", "type": "DRG" } ],"standard_charges":[{"minimum":2205.0000,"maximum":2205.0000,"gross_charge":2205.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure\/AtriClip FLEX V #45","code_information":[ { "code": "3021066", "type": "DRG" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure\/AtriClip FLEX V 50","code_information":[ { "code": "3021067", "type": "DRG" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure\/AtriClip FLEX V 35","code_information":[ { "code": "3020713", "type": "DRG" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AtriCure\/AtriClip FLEX V 40","code_information":[ { "code": "3021065", "type": "DRG" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Atrion QL 2530 Disposable Inflation","code_information":[ { "code": "270000205", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Atrion QL38 Locking Syringe Device","code_information":[ { "code": "270000207", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Ability MRI SureScan 4196-78","code_information":[ { "code": "2720393", "type": "DRG" } ],"standard_charges":[{"minimum":756.0000,"maximum":756.0000,"gross_charge":756.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Command + SureValve 6250V-MB2","code_information":[ { "code": "270000011", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Command + SureValve 6250V-MP","code_information":[ { "code": "270000013", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Command + SureValve 6250V-MPR","code_information":[ { "code": "270000015", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Command+ SureValve 6250V-EH","code_information":[ { "code": "270000017", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ATTAIN HYBRID Guide Wire GWR419688","code_information":[ { "code": "270000019", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Performa MRI SureScan 4298- 88","code_information":[ { "code": "2701548", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Performa MRI SureScan 4298-78","code_information":[ { "code": "2820686", "type": "DRG" } ],"standard_charges":[{"minimum":1960.0000,"maximum":1960.0000,"gross_charge":1960.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Performa Straight MRI SureScan","code_information":[ { "code": "2720944", "type": "DRG" } ],"standard_charges":[{"minimum":700.0000,"maximum":700.0000,"gross_charge":700.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Select II + Sure Valve","code_information":[ { "code": "270000021", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Select II + SureValve","code_information":[ { "code": "270000023", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attain Stability Quad MRI SureScan","code_information":[ { "code": "3021029", "type": "DRG" } ],"standard_charges":[{"minimum":973.0000,"maximum":973.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Attesta DR MRI SureScan ATDR01","code_information":[ { "code": "3020146", "type": "DRG" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Auto Suture Circular Stapler with DST","code_information":[ { "code": "2760737", "type": "DRG" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Auto Transfusion Complete Kit (Wash","code_information":[ { "code": "3021054", "type": "DRG" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Autologous blood or component, collection processing and storage; predeposited","code_information":[ { "code": "86890", "type": "DRG" } ],"standard_charges":[{"minimum":250.0000,"maximum":250.0000,"gross_charge":250.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Avanti Introducer 10F\/11cm","code_information":[ { "code": "270000209", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Avanti Introducer 5F\/11cm","code_information":[ { "code": "270000213", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Avanti Introducer 6Fr\/11cm","code_information":[ { "code": "270000215", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Avanti Introducer 7F\/11cm","code_information":[ { "code": "270000217", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021249", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021250", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021251", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001361", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001363", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001365", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001371", "type": "DRG" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001359", "type": "DRG" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001367", "type": "DRG" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001369", "type": "DRG" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AZUR Detachment Controller","code_information":[ { "code": "3021248", "type": "DRG" } ],"standard_charges":[{"minimum":186.0000,"maximum":186.0000,"gross_charge":186.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Azure XT DR MRI SureScan W1DR01","code_information":[ { "code": "3019421", "type": "DRG" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Azure XT SR MRI SureScan W1SR01","code_information":[ { "code": "3019301", "type": "DRG" } ],"standard_charges":[{"minimum":2310.0000,"maximum":2310.0000,"gross_charge":2310.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Babesia microti, amplified probe technique","code_information":[ { "code": "87469", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Baby Rx Oxygenators Neonatal","code_information":[ { "code": "2780945", "type": "DRG" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bacterial Detection PCR - Infectious Agent Antigen Detection; amplified probe technique","code_information":[ { "code": "87801", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bair Hugger","code_information":[ { "code": "2700097", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Balloon Catheter Model 6714 6F 90cm","code_information":[ { "code": "270000219", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Band 638bl #26 CG Future Anulo 29L","code_information":[ { "code": "2800636", "type": "DRG" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Banding Pulmonary Artery","code_information":[ { "code": "33690", "type": "DRG" } ],"standard_charges":[{"minimum":1660.9700,"maximum":1660.9700,"gross_charge":1660.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1660.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Barbiturates","code_information":[ { "code": "80345", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Basic Metabolic Panel","code_information":[ { "code": "80048", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Benzodiazepines; 1 - 12","code_information":[ { "code": "80346", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"b-Hexosaminidase, each assay","code_information":[ { "code": "83080", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"BI-Cava Fem Cannula 24\/29","code_information":[ { "code": "2760250", "type": "DRG" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bilirubin; direct","code_information":[ { "code": "82248", "type": "DRG" } ],"standard_charges":[{"minimum":5.0000,"maximum":5.0000,"gross_charge":5.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bilirubin; total","code_information":[ { "code": "82247", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bio pump Perfusion Service (Biomedics","code_information":[ { "code": "2740010", "type": "DRG" } ],"standard_charges":[{"minimum":299.0000,"maximum":299.0000,"gross_charge":299.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"BioGlue Syringe Surgical Adhesive 5 ml","code_information":[ { "code": "270001129", "type": "DRG" } ],"standard_charges":[{"minimum":653.8000,"maximum":653.8000,"gross_charge":653.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bio-Medicus Percutaneus Kit 25F","code_information":[ { "code": "270000265", "type": "DRG" } ],"standard_charges":[{"minimum":1008.0000,"maximum":1008.0000,"gross_charge":1008.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Biopsy of the liver, needle; percutaneous","code_information":[ { "code": "47000", "type": "DRG" } ],"standard_charges":[{"minimum":118.3700,"maximum":118.3700,"gross_charge":118.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":118.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Biopsy Valve MAJ 210","code_information":[ { "code": "3008851", "type": "DRG" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bipolar Pacing 5 Fr","code_information":[ { "code": "2710634", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bipolar Temporary Pacing","code_information":[ { "code": "2770176", "type": "DRG" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bladeless Trocars with Stability","code_information":[ { "code": "270000277", "type": "DRG" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blake Drain # 15","code_information":[ { "code": "270001131", "type": "DRG" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blake Drain # 19","code_information":[ { "code": "270001133", "type": "DRG" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blake Drains # 10","code_information":[ { "code": "270001135", "type": "DRG" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blastomyces","code_information":[ { "code": "86612", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bleeding Time","code_information":[ { "code": "85002", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blod count; hematocrit","code_information":[ { "code": "85014", "type": "DRG" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blod count; Hemoglobin","code_information":[ { "code": "85018", "type": "DRG" } ],"standard_charges":[{"minimum":18.2000,"maximum":18.2000,"gross_charge":18.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood (whole) for transfusion, per unit","code_information":[ { "code": "P9010", "type": "DRG" } ],"standard_charges":[{"minimum":180.0000,"maximum":180.0000,"gross_charge":180.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood Bank physicians services; Autorization for deviation from standard blood banking procedures (ex, use of outdated blood, transfusion of RH incompatible untis) with written report","code_information":[ { "code": "86079", "type": "DRG" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood Bank physicians services; difficult cross match and\/or evaluation of irregular antibody(s), interpretationand written report","code_information":[ { "code": "86077", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood Bank physicians services; investigation of transfusion reaction including suspicion of transissible disease, interpretation and written report","code_information":[ { "code": "86078", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)","code_information":[ { "code": "85027", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differencial WBC count","code_information":[ { "code": "85025", "type": "DRG" } ],"standard_charges":[{"minimum":20.0100,"maximum":20.0100,"gross_charge":20.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood count; Platelet, automated","code_information":[ { "code": "85049", "type": "DRG" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood count; Reticulocyte Manual","code_information":[ { "code": "85044", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood count; reticulocyte, automated, including 1 or more cellular parameters, immature reticulocyte fraction, reticulocyte volumen, direct measurement","code_information":[ { "code": "85046", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood smear, pheripheral, interpretation by physician with written report","code_information":[ { "code": "85060", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood split unit","code_information":[ { "code": "P9011", "type": "DRG" } ],"standard_charges":[{"minimum":225.0000,"maximum":225.0000,"gross_charge":225.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood typing, serologic; ABO","code_information":[ { "code": "86900", "type": "DRG" } ],"standard_charges":[{"minimum":31.5000,"maximum":31.5000,"gross_charge":31.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood typing; RH D","code_information":[ { "code": "86901", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations","code_information":[ { "code": "82274", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening","code_information":[ { "code": "82270", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Blood, occult, by peroxidase activity, qualitative; feces, consecutive collected specimens with single determination, other sources","code_information":[ { "code": "82271", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bordetella","code_information":[ { "code": "86615", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Borrelia burgdorferi","code_information":[ { "code": "86618", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Borrelia burgdorferi confirmatory test","code_information":[ { "code": "86617", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Borrelia burgdorferi, amplified probe technique","code_information":[ { "code": "87476", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Borrelia miyamotoi, amplified probe technique","code_information":[ { "code": "87478", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bowl (SP Multipurpose Container)","code_information":[ { "code": "2705406", "type": "DRG" } ],"standard_charges":[{"minimum":35.1400,"maximum":35.1400,"gross_charge":35.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscope Cytology Brush G22178","code_information":[ { "code": "270001139", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with destruction of tumor or relief of stenosis by any method other than excision","code_information":[ { "code": "31641", "type": "DRG" } ],"standard_charges":[{"minimum":341.2400,"maximum":341.2400,"gross_charge":341.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with Endobronchial ultrasound guide transtracheal and\/or transbrochial sampling aspiration 3 or more mediastinal and\/or hilar lymph node stations or structures","code_information":[ { "code": "31653", "type": "DRG" } ],"standard_charges":[{"minimum":333.3700,"maximum":333.3700,"gross_charge":333.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":333.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with excisting tumor","code_information":[ { "code": "31640", "type": "DRG" } ],"standard_charges":[{"minimum":332.0700,"maximum":332.0700,"gross_charge":332.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":332.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay","code_information":[ { "code": "31646", "type": "DRG" } ],"standard_charges":[{"minimum":194.4700,"maximum":194.4700,"gross_charge":194.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with therapeutic aspiration of tracheobronchial tree; initial","code_information":[ { "code": "31645", "type": "DRG" } ],"standard_charges":[{"minimum":198.1700,"maximum":198.1700,"gross_charge":198.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with tracheal\/bronchial dilatation or closed reduction of fracture","code_information":[ { "code": "31630", "type": "DRG" } ],"standard_charges":[{"minimum":266.9200,"maximum":266.9200,"gross_charge":266.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy(s) single lobe","code_information":[ { "code": "31628", "type": "DRG" } ],"standard_charges":[{"minimum":236.2500,"maximum":236.2500,"gross_charge":236.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, trachea, main stem and\/or lobar bronchus","code_information":[ { "code": "31629", "type": "DRG" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with placement of tracheal stent(s) (includes tracheal\/bronchial dilation as required)","code_information":[ { "code": "31631", "type": "DRG" } ],"standard_charges":[{"minimum":304.0700,"maximum":304.0700,"gross_charge":304.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with removal of foreing body","code_information":[ { "code": "31635", "type": "DRG" } ],"standard_charges":[{"minimum":236.2100,"maximum":236.2100,"gross_charge":236.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":236.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial lung biopsy each additional lobe","code_information":[ { "code": "31632", "type": "DRG" } ],"standard_charges":[{"minimum":65.5800,"maximum":65.5800,"gross_charge":65.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy rigid or flexible including fluoroscopic guidance when performed; with transbronchial needle aspiration biopsy, each additional lobe","code_information":[ { "code": "31633", "type": "DRG" } ],"standard_charges":[{"minimum":85.7600,"maximum":85.7600,"gross_charge":85.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; diagnostic, with cell washing, when performed","code_information":[ { "code": "31622", "type": "DRG" } ],"standard_charges":[{"minimum":178.8600,"maximum":178.8600,"gross_charge":178.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":181.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial alveolar lavage","code_information":[ { "code": "31624", "type": "DRG" } ],"standard_charges":[{"minimum":179.8400,"maximum":179.8400,"gross_charge":179.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":179.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.8300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial or endobronchial biopsy single or multiple sites","code_information":[ { "code": "31625", "type": "DRG" } ],"standard_charges":[{"minimum":210.0800,"maximum":210.0800,"gross_charge":210.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.5700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with brushing or protected brushing","code_information":[ { "code": "31623", "type": "DRG" } ],"standard_charges":[{"minimum":177.5500,"maximum":177.5500,"gross_charge":177.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with computer-assisted, image-guided navigation","code_information":[ { "code": "31627", "type": "DRG" } ],"standard_charges":[{"minimum":129.2900,"maximum":129.2900,"gross_charge":129.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":129.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Brucella","code_information":[ { "code": "86622", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Buprenorphine","code_information":[ { "code": "80348", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; aortobifemoral","code_information":[ { "code": "35646", "type": "DRG" } ],"standard_charges":[{"minimum":2282.6600,"maximum":2282.6600,"gross_charge":2282.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2282.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal","code_information":[ { "code": "35631", "type": "DRG" } ],"standard_charges":[{"minimum":2481.2100,"maximum":2481.2100,"gross_charge":2481.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2481.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; aortofemoral","code_information":[ { "code": "35647", "type": "DRG" } ],"standard_charges":[{"minimum":2076.4000,"maximum":2076.4000,"gross_charge":2076.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2076.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; aortoiliac","code_information":[ { "code": "35637", "type": "DRG" } ],"standard_charges":[{"minimum":2221.1700,"maximum":2221.1700,"gross_charge":2221.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2221.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or personal artery","code_information":[ { "code": "35666", "type": "DRG" } ],"standard_charges":[{"minimum":1755.1100,"maximum":1755.1100,"gross_charge":1755.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1726.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; femoral-femoral","code_information":[ { "code": "35661", "type": "DRG" } ],"standard_charges":[{"minimum":1475.6000,"maximum":1475.6000,"gross_charge":1475.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1475.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Bypass graft, with other than vein; femoral-polpliteal","code_information":[ { "code": "35656", "type": "DRG" } ],"standard_charges":[{"minimum":1437.1100,"maximum":1437.1100,"gross_charge":1437.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1437.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"C A 19 22","code_information":[ { "code": "86301", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"C Reactive Protein","code_information":[ { "code": "86140", "type": "DRG" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"C V Pediatric Pack (Bundle)","code_information":[ { "code": "270001141", "type": "DRG" } ],"standard_charges":[{"minimum":173.2500,"maximum":173.2500,"gross_charge":173.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Calcitonin","code_information":[ { "code": "82308", "type": "DRG" } ],"standard_charges":[{"minimum":154.0000,"maximum":154.0000,"gross_charge":154.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":154.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Calcium Alginate Dressing 4 X 4","code_information":[ { "code": "2709142", "type": "DRG" } ],"standard_charges":[{"minimum":65.4900,"maximum":65.4900,"gross_charge":65.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Calcium; ionized","code_information":[ { "code": "82330", "type": "DRG" } ],"standard_charges":[{"minimum":82.9500,"maximum":82.9500,"gross_charge":82.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Calcium; total","code_information":[ { "code": "82310", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Calcium; urine quantitative, timed specimen","code_information":[ { "code": "82340", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Candida species, direct probe technique","code_information":[ { "code": "87480", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cannabinoids, natural","code_information":[ { "code": "80349", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Capsure EPI 4968-35 cm","code_information":[ { "code": "2700317", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CapSure Fix vus MRI Sure Scan","code_information":[ { "code": "2700329", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CapSure Fix vus MRI SureScan","code_information":[ { "code": "2711312", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CapSure Sense MRI SureScan 4074-58 cm","code_information":[ { "code": "2700313", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CapSure Sense MRI SureScan 4574-53 cm","code_information":[ { "code": "2700326", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Captura Biopsy Forceps W Spike 160 cm","code_information":[ { "code": "2700455", "type": "DRG" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Captura Biopsy Forceps With Spike 230","code_information":[ { "code": "270001143", "type": "DRG" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carbamazepine; free","code_information":[ { "code": "80157", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carbamazepine; total","code_information":[ { "code": "80156", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carbon dioxide (Bicarbonate)","code_information":[ { "code": "82374", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carcinoembryonic Antigen (CEA)","code_information":[ { "code": "82378", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardiolipin Antibody Ig","code_information":[ { "code": "86147", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardioplegia Cannula 16 Ga","code_information":[ { "code": "2703860", "type": "DRG" } ],"standard_charges":[{"minimum":230.0000,"maximum":230.0000,"gross_charge":230.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardioplegia Pack Perfusion","code_information":[ { "code": "2740005", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardiopulmonary Bypass Perfusion","code_information":[ { "code": "360001727", "type": "DRG" } ],"standard_charges":[{"minimum":3107.9300,"maximum":3107.9300,"gross_charge":3107.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardiore Forceps","code_information":[ { "code": "3021116", "type": "DRG" } ],"standard_charges":[{"minimum":3969.0000,"maximum":3969.0000,"gross_charge":3969.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardioroot Woven Collagen Coated","code_information":[ { "code": "2890204", "type": "DRG" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardiotomy Reservoir","code_information":[ { "code": "2703070", "type": "DRG" } ],"standard_charges":[{"minimum":150.0000,"maximum":150.0000,"gross_charge":150.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exersice, continuos electrocardiographic monitoring, and\/or pharmacological stress; tracing only, without interpretation and report","code_information":[ { "code": "93017", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cardioversion elective, electrical of arrhythmia; external","code_information":[ { "code": "92960", "type": "DRG" } ],"standard_charges":[{"minimum":145.9800,"maximum":145.9800,"gross_charge":145.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carnitine (total and free), quantitative, each specimen","code_information":[ { "code": "82379", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Carotid Artery Loop Shunt","code_information":[ { "code": "270001145", "type": "DRG" } ],"standard_charges":[{"minimum":34.3000,"maximum":34.3000,"gross_charge":34.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Catecholamine; fractionated","code_information":[ { "code": "82384", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Catheter 227F3 Freezor XTRA3 MED7F","code_information":[ { "code": "3019976", "type": "DRG" } ],"standard_charges":[{"minimum":1470.0000,"maximum":1470.0000,"gross_charge":1470.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed","code_information":[ { "code": "93458", "type": "DRG" } ],"standard_charges":[{"minimum":1416.8800,"maximum":1416.8800,"gross_charge":1416.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1416.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with rigth and left heart catherrization including intraprocedural injections for left ventricullography, when performd","code_information":[ { "code": "93460", "type": "DRG" } ],"standard_charges":[{"minimum":1690.7500,"maximum":1690.7500,"gross_charge":1690.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1690.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cell count, miscellaneous body fluids; except blood","code_information":[ { "code": "89050", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cell count, miscellaneous body fluids; with diferencial count","code_information":[ { "code": "89051", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cellerate RX Surgical Activated","code_information":[ { "code": "270001149", "type": "DRG" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central nervous system pathogen, includes multiplex reverse transcription, when performed, and mutiplex amplied probe technique, multiples types or subtypes, 12-25 targets","code_information":[ { "code": "87483", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Catheter Set 3.0 fr\/5","code_information":[ { "code": "2708243", "type": "DRG" } ],"standard_charges":[{"minimum":137.2000,"maximum":137.2000,"gross_charge":137.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Catheter Set 3.0Fr\/5cm","code_information":[ { "code": "270000303", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Catheter Set 3.0Fr\/8cm","code_information":[ { "code": "270000305", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Catheter Set 4.0Fr\/12cm","code_information":[ { "code": "270000307", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Catheter Set 5.0Fr\/15cm","code_information":[ { "code": "270000309", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000311", "type": "DRG" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000313", "type": "DRG" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cetacaine Topical Anesthetic Spray","code_information":[ { "code": "270001151", "type": "DRG" } ],"standard_charges":[{"minimum":72.6500,"maximum":72.6500,"gross_charge":72.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S 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separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CG FUTURE Annuloplasty Ring 638R 24 mm","code_information":[ { "code": "3021046", "type": "DRG" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chemiluminescent assay","code_information":[ { "code": "82397", "type": "DRG" } ],"standard_charges":[{"minimum":80.0800,"maximum":80.0800,"gross_charge":80.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":80.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chlamydia","code_information":[ { "code": "86631", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chlamydia IgM","code_information":[ { "code": "86632", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chlamydia trachomatis; amplified Probe Technique","code_information":[ { "code": "87491", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chloride; blood","code_information":[ { "code": "82435", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chloride; other source","code_information":[ { "code": "82438", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chloride; urine","code_information":[ { "code": "82436", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cholesterol Body Fluid","code_information":[ { "code": "84265", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cholesterol, serum or whole blood, total","code_information":[ { "code": "82465", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Chromosome analysis; count 5 cells, 1 Karyotype, with banding","code_information":[ { "code": "88261", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cidex OPA","code_information":[ { "code": "2702250", "type": "DRG" } ],"standard_charges":[{"minimum":39.7300,"maximum":39.7300,"gross_charge":39.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Citrate","code_information":[ { "code": "82507", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Claria MRI CRT-D SureScan DTMA1D1","code_information":[ { "code": "3019127", "type": "DRG" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Claria MRI QUAD CRT-D SureScan DTMA1Q1","code_information":[ { "code": "3019577", "type": "DRG" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clostridioides Differential Tox A B","code_information":[ { "code": "87324", "type": "DRG" } ],"standard_charges":[{"minimum":34.9400,"maximum":34.9400,"gross_charge":34.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.9400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clostridium difficile toxin","code_information":[ { "code": "87230", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Closure of median sternotomy separation with or without debridement (separate procedure)","code_information":[ { "code": "21750", "type": "DRG" } ],"standard_charges":[{"minimum":925.2600,"maximum":925.2600,"gross_charge":925.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":925.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":940.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Closure of single ventricular septal defect, with or without patch","code_information":[ { "code": "33681", "type": "DRG" } ],"standard_charges":[{"minimum":2496.3400,"maximum":2496.3400,"gross_charge":2496.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2496.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity","code_information":[ { "code": "85300", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, antigen assy","code_information":[ { "code": "85301", "type": "DRG" } ],"standard_charges":[{"minimum":168.0000,"maximum":168.0000,"gross_charge":168.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Activity","code_information":[ { "code": "85303", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clotting inhibitors or anticoagulants; Protein C Antigen","code_information":[ { "code": "85302", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clotting inhibitors or anticoagulants; Protein S Free","code_information":[ { "code": "85306", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Clozapine","code_information":[ { "code": "80159", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CO- Set Room Temperature System","code_information":[ { "code": "2701461", "type": "DRG" } ],"standard_charges":[{"minimum":37.8000,"maximum":37.8000,"gross_charge":37.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coagulation time; activated","code_information":[ { "code": "85347", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cobalt XT DR MRI SureScan DDPA2D4","code_information":[ { "code": "3019304", "type": "DRG" } ],"standard_charges":[{"minimum":15393.0000,"maximum":15393.0000,"gross_charge":15393.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cobalt XT HF CRT-D MRI SureScan","code_information":[ { "code": "3019873", "type": "DRG" } ],"standard_charges":[{"minimum":16793.0000,"maximum":16793.0000,"gross_charge":16793.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cobalt XT VR MRI Sure Scan DVPA2D4","code_information":[ { "code": "3019303", "type": "DRG" } ],"standard_charges":[{"minimum":13993.0000,"maximum":13993.0000,"gross_charge":13993.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cocaine","code_information":[ { "code": "80353", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coccidioides","code_information":[ { "code": "86635", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coda Balloon Catheter, 9 Fr, 120 cm L","code_information":[ { "code": "270000321", "type": "DRG" } ],"standard_charges":[{"minimum":826.0000,"maximum":826.0000,"gross_charge":826.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cold Agglutinin Screen","code_information":[ { "code": "86156", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cold Agglutinin Titer","code_information":[ { "code": "86157", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, partial, with removal of terminal ileum or ileocolostomy","code_information":[ { "code": "44160", "type": "DRG" } ],"standard_charges":[{"minimum":1731.8700,"maximum":1731.8700,"gross_charge":1731.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1731.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, partial; with anastomosis","code_information":[ { "code": "44140", "type": "DRG" } ],"standard_charges":[{"minimum":1841.4300,"maximum":1841.4300,"gross_charge":1841.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1841.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, partial; with coloproctostomy, with colostomy","code_information":[ { "code": "44146", "type": "DRG" } ],"standard_charges":[{"minimum":2915.7800,"maximum":2915.7800,"gross_charge":2915.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2915.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, partial; with resection, with colostomy or ileostomy and creation of a mucofistula","code_information":[ { "code": "44144", "type": "DRG" } ],"standard_charges":[{"minimum":2453.4300,"maximum":2453.4300,"gross_charge":2453.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2453.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, partial; with skin-level cecostomy or colostomy","code_information":[ { "code": "44141", "type": "DRG" } ],"standard_charges":[{"minimum":2524.1200,"maximum":2524.1200,"gross_charge":2524.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2524.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy","code_information":[ { "code": "44150", "type": "DRG" } ],"standard_charges":[{"minimum":2534.4800,"maximum":2534.4800,"gross_charge":2534.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2534.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Collage cross links, any method","code_information":[ { "code": "82523", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Collection of capillary blood specimens","code_information":[ { "code": "36416", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "45378", "type": "DRG" } ],"standard_charges":[{"minimum":250.0500,"maximum":250.0500,"gross_charge":250.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed, with biopsy, single or multiple","code_information":[ { "code": "45380", "type": "DRG" } ],"standard_charges":[{"minimum":271.6400,"maximum":271.6400,"gross_charge":271.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Colostomy or skin level cecostomy","code_information":[ { "code": "44320", "type": "DRG" } ],"standard_charges":[{"minimum":1648.0200,"maximum":1648.0200,"gross_charge":1648.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1648.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Column chromatography, including mass spectrometry, if performed, non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen","code_information":[ { "code": "82542", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Compatibility test incubated technique","code_information":[ { "code": "86921", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Compatibility test; Antiglobulin technique","code_information":[ { "code": "86922", "type": "DRG" } ],"standard_charges":[{"minimum":102.0000,"maximum":102.0000,"gross_charge":102.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Compatibility test; Immediate spin technique","code_information":[ { "code": "86920", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Complement; antigen, each component","code_information":[ { "code": "86160", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Complement; Total hemolytic CH50","code_information":[ { "code": "86162", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Complete Repair anomalous pulmonary venous return","code_information":[ { "code": "33730", "type": "DRG" } ],"standard_charges":[{"minimum":2708.6800,"maximum":2708.6800,"gross_charge":2708.6800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2708.6800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Complete repair tetralogy of fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect","code_information":[ { "code": "33697", "type": "DRG" } ],"standard_charges":[{"minimum":2768.2800,"maximum":2768.2800,"gross_charge":2768.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2768.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Complete repair tetralogy of Fallot without pulmonary atresia","code_information":[ { "code": "33692", "type": "DRG" } ],"standard_charges":[{"minimum":2630.6600,"maximum":2630.6600,"gross_charge":2630.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2630.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with rigth atrial pacing and recording, rigth ventricular pacing and recording, His bundle recording","code_information":[ { "code": "93620", "type": "DRG" } ],"standard_charges":[{"minimum":9425.8500,"maximum":9425.8500,"gross_charge":9425.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9425.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Comprehensive Metabolic Panel","code_information":[ { "code": "80053", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, abdomen and pelvis with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74174", "type": "DRG" } ],"standard_charges":[{"minimum":566.1500,"maximum":566.1500,"gross_charge":566.1500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":566.1500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "74175", "type": "DRG" } ],"standard_charges":[{"minimum":456.3300,"maximum":456.3300,"gross_charge":456.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and images postprogressing","code_information":[ { "code": "75635", "type": "DRG" } ],"standard_charges":[{"minimum":582.5300,"maximum":582.5300,"gross_charge":582.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":607.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "71275", "type": "DRG" } ],"standard_charges":[{"minimum":417.5900,"maximum":417.5900,"gross_charge":417.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":417.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70496", "type": "DRG" } ],"standard_charges":[{"minimum":409.9600,"maximum":409.9600,"gross_charge":409.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.9600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, heart, coronary arteries and bypass grafts(when present), with contrast material, including 3D image postprocessing (including evalution of cardiac structure and morphology assessment of cardiac funtion, and evaluation of venuos structures, if performed)","code_information":[ { "code": "75574", "type": "DRG" } ],"standard_charges":[{"minimum":456.0600,"maximum":456.0600,"gross_charge":456.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":473.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprocessing","code_information":[ { "code": "73706", "type": "DRG" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing","code_information":[ { "code": "70498", "type": "DRG" } ],"standard_charges":[{"minimum":409.4900,"maximum":409.4900,"gross_charge":409.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, pelvis, with contrast material(s), include noncontrast images, if performed, and image postprogressing","code_information":[ { "code": "72191", "type": "DRG" } ],"standard_charges":[{"minimum":453.9400,"maximum":453.9400,"gross_charge":453.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.9400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if perfomed, and image postprogressing","code_information":[ { "code": "73206", "type": "DRG" } ],"standard_charges":[{"minimum":481.1700,"maximum":481.1700,"gross_charge":481.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":481.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography guidance for needle placement, (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation","code_information":[ { "code": "77012", "type": "DRG" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen and pelvis; with contrast material","code_information":[ { "code": "74177", "type": "DRG" } ],"standard_charges":[{"minimum":454.4400,"maximum":454.4400,"gross_charge":454.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material","code_information":[ { "code": "74176", "type": "DRG" } ],"standard_charges":[{"minimum":270.8300,"maximum":270.8300,"gross_charge":270.8300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.8300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and futher sections in one or both body regions","code_information":[ { "code": "74178", "type": "DRG" } ],"standard_charges":[{"minimum":508.8700,"maximum":508.8700,"gross_charge":508.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":508.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen; with contrast material","code_information":[ { "code": "74160", "type": "DRG" } ],"standard_charges":[{"minimum":349.4700,"maximum":349.4700,"gross_charge":349.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":349.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen; without contrast material","code_information":[ { "code": "74150", "type": "DRG" } ],"standard_charges":[{"minimum":202.2300,"maximum":202.2300,"gross_charge":202.2300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":202.2300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, abdomen; without contrast material followed by contrast material and futher sections","code_information":[ { "code": "74170", "type": "DRG" } ],"standard_charges":[{"minimum":391.9900,"maximum":391.9900,"gross_charge":391.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, cervical spine; with contrast material","code_information":[ { "code": "72126", "type": "DRG" } ],"standard_charges":[{"minimum":250.0300,"maximum":250.0300,"gross_charge":250.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, cervical spine; without contrast material","code_information":[ { "code": "72125", "type": "DRG" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72127", "type": "DRG" } ],"standard_charges":[{"minimum":293.0300,"maximum":293.0300,"gross_charge":293.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":293.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, head or brain; with contrast material","code_information":[ { "code": "70460", "type": "DRG" } ],"standard_charges":[{"minimum":218.9900,"maximum":218.9900,"gross_charge":218.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, head or brain; without contrast material","code_information":[ { "code": "70450", "type": "DRG" } ],"standard_charges":[{"minimum":156.9500,"maximum":156.9500,"gross_charge":156.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, head or brain; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70470", "type": "DRG" } ],"standard_charges":[{"minimum":257.6600,"maximum":257.6600,"gross_charge":257.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":257.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, heart, with contrast materials, for evaluate of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)","code_information":[ { "code": "75572", "type": "DRG" } ],"standard_charges":[{"minimum":335.3800,"maximum":335.3800,"gross_charge":335.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":335.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium","code_information":[ { "code": "75571", "type": "DRG" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lower extremity; with contrast material","code_information":[ { "code": "73701", "type": "DRG" } ],"standard_charges":[{"minimum":247.1800,"maximum":247.1800,"gross_charge":247.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lower extremity; without contrast material","code_information":[ { "code": "73700", "type": "DRG" } ],"standard_charges":[{"minimum":191.3200,"maximum":191.3200,"gross_charge":191.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections","code_information":[ { "code": "73702", "type": "DRG" } ],"standard_charges":[{"minimum":289.7300,"maximum":289.7300,"gross_charge":289.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lumbar spine; with contrast material","code_information":[ { "code": "72132", "type": "DRG" } ],"standard_charges":[{"minimum":250.5200,"maximum":250.5200,"gross_charge":250.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lumbar spine; without contrast material","code_information":[ { "code": "72131", "type": "DRG" } ],"standard_charges":[{"minimum":190.8500,"maximum":190.8500,"gross_charge":190.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72133", "type": "DRG" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, maxillofacial area; with contrast material","code_information":[ { "code": "70487", "type": "DRG" } ],"standard_charges":[{"minimum":225.2000,"maximum":225.2000,"gross_charge":225.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, maxillofacial area; without contrast material","code_information":[ { "code": "70486", "type": "DRG" } ],"standard_charges":[{"minimum":189.9500,"maximum":189.9500,"gross_charge":189.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70488", "type": "DRG" } ],"standard_charges":[{"minimum":274.3900,"maximum":274.3900,"gross_charge":274.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; with contrast material","code_information":[ { "code": "70481", "type": "DRG" } ],"standard_charges":[{"minimum":268.2400,"maximum":268.2400,"gross_charge":268.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material","code_information":[ { "code": "70480", "type": "DRG" } ],"standard_charges":[{"minimum":234.7100,"maximum":234.7100,"gross_charge":234.7100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":234.7100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, orbit, sella, posterior fossa, or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "70482", "type": "DRG" } ],"standard_charges":[{"minimum":313.1200,"maximum":313.1200,"gross_charge":313.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, pelvis; with contrast material(s)","code_information":[ { "code": "72193", "type": "DRG" } ],"standard_charges":[{"minimum":343.3100,"maximum":343.3100,"gross_charge":343.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, pelvis; without contrast material","code_information":[ { "code": "72192", "type": "DRG" } ],"standard_charges":[{"minimum":197.0100,"maximum":197.0100,"gross_charge":197.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, pelvis; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72194", "type": "DRG" } ],"standard_charges":[{"minimum":378.6700,"maximum":378.6700,"gross_charge":378.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":378.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, soft tissue neck; with contrast material(s)","code_information":[ { "code": "70491", "type": "DRG" } ],"standard_charges":[{"minimum":273.8700,"maximum":273.8700,"gross_charge":273.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, soft tissue neck; without contrast material","code_information":[ { "code": "70490", "type": "DRG" } ],"standard_charges":[{"minimum":222.2800,"maximum":222.2800,"gross_charge":222.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":222.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and futher sections","code_information":[ { "code": "70492", "type": "DRG" } ],"standard_charges":[{"minimum":329.2400,"maximum":329.2400,"gross_charge":329.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thoracic spine; with contrast material","code_information":[ { "code": "72129", "type": "DRG" } ],"standard_charges":[{"minimum":251.9300,"maximum":251.9300,"gross_charge":251.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thoracic spine; without contrast material","code_information":[ { "code": "72128", "type": "DRG" } ],"standard_charges":[{"minimum":191.8000,"maximum":191.8000,"gross_charge":191.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "72130", "type": "DRG" } ],"standard_charges":[{"minimum":295.9000,"maximum":295.9000,"gross_charge":295.9000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.9000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thorax, diagnostic; with contrast material(s)","code_information":[ { "code": "71260", "type": "DRG" } ],"standard_charges":[{"minimum":240.7400,"maximum":240.7400,"gross_charge":240.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":247.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material","code_information":[ { "code": "71250", "type": "DRG" } ],"standard_charges":[{"minimum":191.5100,"maximum":191.5100,"gross_charge":191.5100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "71270", "type": "DRG" } ],"standard_charges":[{"minimum":291.6200,"maximum":291.6200,"gross_charge":291.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, upper extremity; with contrast material(s)","code_information":[ { "code": "73201", "type": "DRG" } ],"standard_charges":[{"minimum":299.7800,"maximum":299.7800,"gross_charge":299.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, upper extremity; without contrast material","code_information":[ { "code": "73200", "type": "DRG" } ],"standard_charges":[{"minimum":240.1000,"maximum":240.1000,"gross_charge":240.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and futher sections","code_information":[ { "code": "73202", "type": "DRG" } ],"standard_charges":[{"minimum":371.9800,"maximum":371.9800,"gross_charge":371.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Confida Brecker Guideware 30mm X 260cm","code_information":[ { "code": "270001153", "type": "DRG" } ],"standard_charges":[{"minimum":274.4000,"maximum":274.4000,"gross_charge":274.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Confirm RX","code_information":[ { "code": "3019024", "type": "DRG" } ],"standard_charges":[{"minimum":3480.0000,"maximum":3480.0000,"gross_charge":3480.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Contegra 200 12mm (Model 200H12)","code_information":[ { "code": "2780680", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Contour 3D 690R Annuloplasty Tricuspid","code_information":[ { "code": "2820125", "type": "DRG" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Control nasal hemorrhage, anterior, complex (extensive cautery\/or packing) any method","code_information":[ { "code": "30903", "type": "DRG" } ],"standard_charges":[{"minimum":107.1300,"maximum":107.1300,"gross_charge":107.1300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":107.1300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Copper","code_information":[ { "code": "82525", "type": "DRG" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, using arterial grafts; single arterial graft","code_information":[ { "code": "33533", "type": "DRG" } ],"standard_charges":[{"minimum":2523.0000,"maximum":2523.0000,"gross_charge":2523.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2523.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, vein only ; 2 coronary venous graft","code_information":[ { "code": "33511", "type": "DRG" } ],"standard_charges":[{"minimum":2860.4500,"maximum":2860.4500,"gross_charge":2860.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, vein only ; 3 coronary venous graft","code_information":[ { "code": "33512", "type": "DRG" } ],"standard_charges":[{"minimum":3258.2500,"maximum":3258.2500,"gross_charge":3258.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3258.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, vein only ; 4 coronary venous graft","code_information":[ { "code": "33513", "type": "DRG" } ],"standard_charges":[{"minimum":3354.4400,"maximum":3354.4400,"gross_charge":3354.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3354.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, vein only ; 5 coronary venous graft","code_information":[ { "code": "33514", "type": "DRG" } ],"standard_charges":[{"minimum":3497.7000,"maximum":3497.7000,"gross_charge":3497.7000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3497.7000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Artery Bypass, vein only ; single coronary venous","code_information":[ { "code": "33510", "type": "DRG" } ],"standard_charges":[{"minimum":2604.9500,"maximum":2604.9500,"gross_charge":2604.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2604.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Care Unit (CCU)","code_information":[ { "code": "210000001", "type": "DRG" } ],"standard_charges":[{"minimum":1919.4000,"maximum":759.0000,"gross_charge":1919.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Coronary Ostial Perfusion Cannula #10","code_information":[ { "code": "3020680", "type": "DRG" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cortisol; free","code_information":[ { "code": "82530", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cortisol; total","code_information":[ { "code": "82533", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPB Custom Perfusion Pack","code_information":[ { "code": "2740000", "type": "DRG" } ],"standard_charges":[{"minimum":1285.2000,"maximum":1285.2000,"gross_charge":1285.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"C-peptide","code_information":[ { "code": "84681", "type": "DRG" } ],"standard_charges":[{"minimum":83.2000,"maximum":83.2000,"gross_charge":83.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000025", "type": "DRG" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000335", "type": "DRG" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000337", "type": "DRG" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000339", "type": "DRG" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct SLII Slittable Outer Guide","code_information":[ { "code": "270000027", "type": "DRG" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CPS Direct Universal Slittable Outer","code_information":[ { "code": "270000341", "type": "DRG" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Creatine Kinase (CK), (CPK); total","code_information":[ { "code": "82550", "type": "DRG" } ],"standard_charges":[{"minimum":26.6000,"maximum":26.6000,"gross_charge":26.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Creatinine; blood","code_information":[ { "code": "82565", "type": "DRG" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Creatinine; Clearance","code_information":[ { "code": "82575", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Creatinine; other source","code_information":[ { "code": "82570", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Creation of pericardial window or partial resection for drainage","code_information":[ { "code": "33025", "type": "DRG" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryo Aortic Heart Valve","code_information":[ { "code": "2710958", "type": "DRG" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryo Cryo Femoral Vein","code_information":[ { "code": "2820137", "type": "DRG" } ],"standard_charges":[{"minimum":6619.2000,"maximum":6619.2000,"gross_charge":6619.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryo Pulmonary Heart Valve","code_information":[ { "code": "2780235", "type": "DRG" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryo Pulmonary Pact Thin","code_information":[ { "code": "3020837", "type": "DRG" } ],"standard_charges":[{"minimum":8850.8000,"maximum":8850.8000,"gross_charge":8850.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryo Pulmonary Patch","code_information":[ { "code": "2770105", "type": "DRG" } ],"standard_charges":[{"minimum":6112.4000,"maximum":6112.4000,"gross_charge":6112.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryoglobulin, qualitative or sem-quantitative","code_information":[ { "code": "82595", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryoprecipitate, each unit","code_information":[ { "code": "P9012", "type": "DRG" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryptococcus Cytomegalovirus (CMV) IgM","code_information":[ { "code": "86645", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryptococcus Cytomegalovirus IgG Antibody","code_information":[ { "code": "86644", "type": "DRG" } ],"standard_charges":[{"minimum":23.8000,"maximum":23.8000,"gross_charge":23.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cryptosporidium Antigen Stool","code_information":[ { "code": "87328", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Crystal identification by light microscopy wit or without polarizing lens analysis, tissue or any body fluid","code_information":[ { "code": "89060", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture bacterial; any other source except urine, blood or stool, aerobic with isolation and presumptive identification of isolates","code_information":[ { "code": "87070", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold 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A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture bacterial; blood aerobic with isolation and presumptive identification of isolates","code_information":[ { "code": "87040", "type": "DRG" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture bacterial; stool, aerobic with isolation and preliminary examination","code_information":[ { "code": "87045", "type": "DRG" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate","code_information":[ { "code": "87046", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate","code_information":[ { "code": "87077", "type": "DRG" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, bacterial; quantitative colony count, urine","code_information":[ { "code": "87086", "type": "DRG" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, bacterial; quantitative, aerobic with isolationand presumptive identification of isolates, any source except urine, blood or stool","code_information":[ { "code": "87071", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; other source","code_information":[ { "code": "87102", "type": "DRG" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; Blood","code_information":[ { "code": "87103", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, Fungi isolation, with presumptive identification of isolate; skin, hair, or nail","code_information":[ { "code": "87101", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, fungi, definitive identification, each organism; yeast","code_information":[ { "code": "87106", "type": "DRG" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, presumptive, pathogenic organism screening only","code_information":[ { "code": "87081", "type": "DRG" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Culture, tubercle or other acid-fast bacilli, any source, with isolative presumptive identification of isolates","code_information":[ { "code": "87116", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Curved Bipolar Dissector","code_information":[ { "code": "3021141", "type": "DRG" } ],"standard_charges":[{"minimum":5556.6000,"maximum":5556.6000,"gross_charge":5556.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cyanocobalamin","code_information":[ { "code": "82607", "type": "DRG" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cyclic Citrullinated Peptide, antibody","code_information":[ { "code": "86200", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cyclosporine","code_information":[ { "code": "80158", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"CYP2C19 gene, analysis; common variants","code_information":[ { "code": "81225", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cytolopathology, selective cellular enhancement technique with interpretation; except cervical or vaginal","code_information":[ { "code": "88112", "type": "DRG" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cytomegalovirus, amplified probe technique","code_information":[ { "code": "87496", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Cytomegalovirus, quantification","code_information":[ { "code": "87497", "type": "DRG" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Debridement subcutaneous tissue; first 20 sq cm or less","code_information":[ { "code": "11042", "type": "DRG" } ],"standard_charges":[{"minimum":84.4600,"maximum":84.4600,"gross_charge":84.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":83.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Debridment bone; first 20 sq cm or less","code_information":[ { "code": "11044", "type": "DRG" } ],"standard_charges":[{"minimum":308.1400,"maximum":308.1400,"gross_charge":308.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Decompression fasciotomy, forear and or wrist, flexor or exttensor compartment; without debridement of nonviable muscle and or nerve","code_information":[ { "code": "25020", "type": "DRG" } ],"standard_charges":[{"minimum":1048.3200,"maximum":1048.3200,"gross_charge":1048.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1048.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Decortication parietal pleurectomy","code_information":[ { "code": "32320", "type": "DRG" } ],"standard_charges":[{"minimum":2179.1800,"maximum":2179.1800,"gross_charge":2179.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2179.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2215.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Decortication, pulmonary partial","code_information":[ { "code": "32225", "type": "DRG" } ],"standard_charges":[{"minimum":1352.7200,"maximum":1352.7200,"gross_charge":1352.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1352.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Decortication, pulmonary total","code_information":[ { "code": "32220", "type": "DRG" } ],"standard_charges":[{"minimum":2173.0700,"maximum":2173.0700,"gross_charge":2173.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2173.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Dehydroepiandrosterone Sulfate (DHEA-S)","code_information":[ { "code": "82627", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Delivery Catheter C315HIS","code_information":[ { "code": "270000029", "type": "DRG" } ],"standard_charges":[{"minimum":280.0000,"maximum":280.0000,"gross_charge":280.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Deoxyribonuclease Antibody","code_information":[ { "code": "86215", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Dermabond Advanced 0.7 ML","code_information":[ { "code": "270000351", "type": "DRG" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Dermacea Sterile Gauzes 4'' X 4''","code_information":[ { "code": "270000353", "type": "DRG" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Dialisis","code_information":[ { "code": "90935", "type": "DRG" } ],"standard_charges":[{"minimum":359.8000,"maximum":359.8000,"gross_charge":359.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":359.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diaphragm imbrication for eventration, transthoracic or transabdominal, paralytic or nonparalytic","code_information":[ { "code": "39545", "type": "DRG" } ],"standard_charges":[{"minimum":1222.3300,"maximum":1222.3300,"gross_charge":1222.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1222.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diaphragma resection with simple repair","code_information":[ { "code": "39560", "type": "DRG" } ],"standard_charges":[{"minimum":1102.6800,"maximum":1102.6800,"gross_charge":1102.6800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.6800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diffusion Membrane Oxigenator","code_information":[ { "code": "2702468", "type": "DRG" } ],"standard_charges":[{"minimum":1164.3400,"maximum":1164.3400,"gross_charge":1164.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Digoxin; total","code_information":[ { "code": "80162", "type": "DRG" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diphtheria enterovirus","code_information":[ { "code": "86658", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage","code_information":[ { "code": "33645", "type": "DRG" } ],"standard_charges":[{"minimum":2335.3800,"maximum":2335.3800,"gross_charge":2335.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2335.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Direct repair of an aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral)","code_information":[ { "code": "35141", "type": "DRG" } ],"standard_charges":[{"minimum":1488.8600,"maximum":1488.8600,"gross_charge":1488.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1488.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Disposable Cytology Brush","code_information":[ { "code": "270001157", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Disposable Surgical Cable (12ft)","code_information":[ { "code": "270000359", "type": "DRG" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Disposable Surgical Cable (8ft)","code_information":[ { "code": "270000357", "type": "DRG" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Disposable Surgical Cable 301-CG(1)","code_information":[ { "code": "270000031", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy, thoracic approach","code_information":[ { "code": "43135", "type": "DRG" } ],"standard_charges":[{"minimum":1992.2700,"maximum":1992.2700,"gross_charge":1992.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1992.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Diverticulectomy of the hypopharynx or esophagus, with or without myotomy; cervical approach","code_information":[ { "code": "43130", "type": "DRG" } ],"standard_charges":[{"minimum":1097.1200,"maximum":1097.1200,"gross_charge":1097.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1097.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"DNA Antibody; native or double stranded","code_information":[ { "code": "86225", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Dormo-Strip","code_information":[ { "code": "270000361", "type": "DRG" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Double Lumen 28 LT","code_information":[ { "code": "2703245", "type": "DRG" } ],"standard_charges":[{"minimum":116.4800,"maximum":116.4800,"gross_charge":116.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Double Transducer","code_information":[ { "code": "2712110", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Drainage of a retroperitoneal abscess, open","code_information":[ { "code": "49060", "type": "DRG" } ],"standard_charges":[{"minimum":1528.8000,"maximum":1528.8000,"gross_charge":1528.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Drainage of Finger abscess; simple","code_information":[ { "code": "26010", "type": "DRG" } ],"standard_charges":[{"minimum":200.9600,"maximum":200.9600,"gross_charge":200.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":200.9600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Drainage of peritoneal abscess or localized peritonitis, exclusive appendiceal abscess, open","code_information":[ { "code": "49020", "type": "DRG" } ],"standard_charges":[{"minimum":2226.6900,"maximum":2226.6900,"gross_charge":2226.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2226.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Drug test presumptive any number of drug classes, any number of devices or procedures; By instrument chemistry analyzers","code_information":[ { "code": "80307", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Duplex scan of extracranial arteries; complete bilateral study","code_information":[ { "code": "93880", "type": "DRG" } ],"standard_charges":[{"minimum":267.1200,"maximum":267.1200,"gross_charge":267.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":273.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Duplex scan of extracranial arteries; unilateral or limited study","code_information":[ { "code": "93882", "type": "DRG" } ],"standard_charges":[{"minimum":175.2500,"maximum":175.2500,"gross_charge":175.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Durata Defibrillation Lead 58 cm","code_information":[ { "code": "2790576", "type": "DRG" } ],"standard_charges":[{"minimum":2366.0000,"maximum":2366.0000,"gross_charge":2366.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endopath Staple Line","code_information":[ { "code": "270001161", "type": "DRG" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021060", "type": "DRG" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021061", "type": "DRG" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021095", "type": "DRG" } ],"standard_charges":[{"minimum":232.4000,"maximum":232.4000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001167", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001171", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001173", "type": "DRG" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001175", "type": "DRG" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001177", "type": "DRG" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001179", "type": "DRG" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Flex 45 Articulating","code_information":[ { "code": "270000373", "type": "DRG" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon flex powered plus articulating","code_information":[ { "code": "270000375", "type": "DRG" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Flex Powered Plus Compact","code_information":[ { "code": "270000377", "type": "DRG" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon Flex Powered Vascular Stapler","code_information":[ { "code": "270000379", "type": "DRG" } ],"standard_charges":[{"minimum":595.0000,"maximum":595.0000,"gross_charge":595.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echelon-Flex 60 Articulating","code_information":[ { "code": "270000381", "type": "DRG" } ],"standard_charges":[{"minimum":441.0000,"maximum":441.0000,"gross_charge":441.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when preformed, during rest and cardiovascular stress test using treadmill, bicycle exercise and\/or pharmacologically induce stress, with interpretation and report; including performance of continuos electrocardiographic monitoring, with supervision by a physician or other qualified health care professional","code_information":[ { "code": "93351", "type": "DRG" } ],"standard_charges":[{"minimum":330.6200,"maximum":330.6200,"gross_charge":330.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":330.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ecmo Membrane","code_information":[ { "code": "2780060", "type": "DRG" } ],"standard_charges":[{"minimum":1176.0000,"maximum":1176.0000,"gross_charge":1176.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ecmo Tubing Pack (Pediatric)","code_information":[ { "code": "2780061", "type": "DRG" } ],"standard_charges":[{"minimum":1052.8000,"maximum":1052.8000,"gross_charge":1052.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards Commander Delivery System","code_information":[ { "code": "270000385", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards Commander Delivery System 20mm","code_information":[ { "code": "270000383", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards Commander Delivery System 26mm","code_information":[ { "code": "270000387", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards Commander Delivery System 29mm","code_information":[ { "code": "270000389", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards Crimper","code_information":[ { "code": "270001181", "type": "DRG" } ],"standard_charges":[{"minimum":469.0000,"maximum":469.0000,"gross_charge":469.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards eSheath+Introducer Set","code_information":[ { "code": "2705070", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001373", "type": "DRG" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001375", "type": "DRG" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001377", "type": "DRG" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001379", "type": "DRG" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"EEA OrVil Auto Suture Transoral","code_information":[ { "code": "2760736", "type": "DRG" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report","code_information":[ { "code": "93000", "type": "DRG" } ],"standard_charges":[{"minimum":19.7700,"maximum":19.7700,"gross_charge":19.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Electrode Multifunction Pediatric","code_information":[ { "code": "2700902", "type": "DRG" } ],"standard_charges":[{"minimum":57.4000,"maximum":57.4000,"gross_charge":57.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Electrolytes panel","code_information":[ { "code": "80051", "type": "DRG" } ],"standard_charges":[{"minimum":22.6100,"maximum":22.6100,"gross_charge":22.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Electrophysiologic evaluation with treatment of supraventricular tachycardia","code_information":[ { "code": "93653", "type": "DRG" } ],"standard_charges":[{"minimum":1118.5600,"maximum":1118.5600,"gross_charge":1118.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1118.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Electrophysiologic evaluation with treatment of ventricular tachycardia or focus of ventricular ectopy","code_information":[ { "code": "93654", "type": "DRG" } ],"standard_charges":[{"minimum":1347.5800,"maximum":1347.5800,"gross_charge":1347.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ellipse DR Implantable Cardioverter","code_information":[ { "code": "3019129", "type": "DRG" } ],"standard_charges":[{"minimum":11905.6000,"maximum":11905.6000,"gross_charge":11905.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ellipse VR Implantable Cardioverter","code_information":[ { "code": "30170052", "type": "DRG" } ],"standard_charges":[{"minimum":10294.2000,"maximum":10294.2000,"gross_charge":10294.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Emblem MRI S-ICD A219","code_information":[ { "code": "3017232", "type": "DRG" } ],"standard_charges":[{"minimum":18816.0000,"maximum":18816.0000,"gross_charge":18816.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Emblem S-ICD 3501 45 CM","code_information":[ { "code": "3017470", "type": "DRG" } ],"standard_charges":[{"minimum":2688.0000,"maximum":2688.0000,"gross_charge":2688.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Embolectomy or thrombectomy, with or without catheter, carotid, subclavian or innominate artery, by neck incision","code_information":[ { "code": "34001", "type": "DRG" } ],"standard_charges":[{"minimum":1227.7200,"maximum":1227.7200,"gross_charge":1227.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1227.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Emerald Guidewire","code_information":[ { "code": "270000401", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Emergency Shunt Kit","code_information":[ { "code": "2706608", "type": "DRG" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Encore 26 Advantage Kit Inflation","code_information":[ { "code": "270000403", "type": "DRG" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo Catch Specimen Retrieval Pouch 15","code_information":[ { "code": "3021169", "type": "DRG" } ],"standard_charges":[{"minimum":630.0000,"maximum":630.0000,"gross_charge":630.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo GIA Articulating ref. egia45amt","code_information":[ { "code": "2800827", "type": "DRG" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo GIA Articulating ref. egia45avt","code_information":[ { "code": "2800995", "type": "DRG" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo GIA Ultra Universal Stapler 12mm","code_information":[ { "code": "2800826", "type": "DRG" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ENDO- SURGERY LINEAR STAPLER RELOAD","code_information":[ { "code": "270001183", "type": "DRG" } ],"standard_charges":[{"minimum":81.2500,"maximum":81.2500,"gross_charge":81.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endomyocardial Biopsy","code_information":[ { "code": "93505", "type": "DRG" } ],"standard_charges":[{"minimum":880.4000,"maximum":880.4000,"gross_charge":880.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":880.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endomysial Antibody, each immunoglobulin","code_information":[ { "code": "86231", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000407", "type": "DRG" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000409", "type": "DRG" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign bodies or stents from the biliary\/pancreatic ducts","code_information":[ { "code": "43275", "type": "DRG" } ],"standard_charges":[{"minimum":516.3200,"maximum":516.3200,"gross_charge":516.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":516.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo-Surgery Linear Cutter Reloads","code_information":[ { "code": "270001185", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001187", "type": "DRG" } ],"standard_charges":[{"minimum":82.8700,"maximum":82.8700,"gross_charge":82.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001189", "type": "DRG" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":82.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ENDO-SURGERY LINEAR STAPLER RELOADS","code_information":[ { "code": "270001191", "type": "DRG" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001193", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001195", "type": "DRG" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endovascular repair of the descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic discruption); involving the coverage of the left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s) if required, to level of celiac artery origin","code_information":[ { "code": "33880", "type": "DRG" } ],"standard_charges":[{"minimum":2431.4900,"maximum":2431.4900,"gross_charge":2431.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2431.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2391.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches","code_information":[ { "code": "33894", "type": "DRG" } ],"standard_charges":[{"minimum":1314.6300,"maximum":1314.6300,"gross_charge":1314.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1314.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1336.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endovenous ablation therapy of incompetent vein in an extremity using radiofrequency for the first vein treated","code_information":[ { "code": "36475", "type": "DRG" } ],"standard_charges":[{"minimum":373.2100,"maximum":373.2100,"gross_charge":373.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":373.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity; by transcatheter delivery of a chemical adhesive remote form the access site, inclusive of all imging guidacne and monitoring percutaneous; first vein treated","code_information":[ { "code": "36482", "type": "DRG" } ],"standard_charges":[{"minimum":240.8700,"maximum":240.8700,"gross_charge":240.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":240.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"EndoWrist Instruments Suction","code_information":[ { "code": "3021115", "type": "DRG" } ],"standard_charges":[{"minimum":389.6700,"maximum":389.6700,"gross_charge":389.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"EndoWrist Stapler Gray 30mm 2.0mm","code_information":[ { "code": "3021145", "type": "DRG" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"EndoWrist Stapler White 30mm 2.5mm","code_information":[ { "code": "3021143", "type": "DRG" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endozime Sponge","code_information":[ { "code": "270001199", "type": "DRG" } ],"standard_charges":[{"minimum":322.0000,"maximum":322.0000,"gross_charge":322.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Endurant II Stent Graft System Limb","code_information":[ { "code": "2740173", "type": "DRG" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enhance Transcarotid Peripheral Access","code_information":[ { "code": "3021036", "type": "DRG" } ],"standard_charges":[{"minimum":2646.0000,"maximum":2646.0000,"gross_charge":2646.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enroute Enflate Transcarotid 5.5x25","code_information":[ { "code": "3021039", "type": "DRG" } ],"standard_charges":[{"minimum":530.6000,"maximum":530.6000,"gross_charge":530.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enroute Transcarotid 0.014 Guidewires","code_information":[ { "code": "3021035", "type": "DRG" } ],"standard_charges":[{"minimum":1477.0000,"maximum":1477.0000,"gross_charge":1477.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enroute Transcarotid Neuroprotection","code_information":[ { "code": "3021034", "type": "DRG" } ],"standard_charges":[{"minimum":5248.6000,"maximum":5248.6000,"gross_charge":5248.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021037", "type": "DRG" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021038", "type": "DRG" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enseal X1 Large Jaw Tissue Sealer 20","code_information":[ { "code": "270000423", "type": "DRG" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ensemble II Transcatheter Valve","code_information":[ { "code": "3019046", "type": "DRG" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enterovirus, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87498", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive subtrate, each specimen","code_information":[ { "code": "82657", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Epstein","code_information":[ { "code": "86665", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Epstein Barr Virus Early Antigen Antibody","code_information":[ { "code": "86663", "type": "DRG" } ],"standard_charges":[{"minimum":90.0100,"maximum":90.0100,"gross_charge":90.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Epstein-Barr Virus Nuclear Antigen Antibody","code_information":[ { "code": "86664", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagectomy, distal two-thirds, , with laparospic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43287", "type": "DRG" } ],"standard_charges":[{"minimum":4813.5500,"maximum":4813.5500,"gross_charge":4813.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4813.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagectomy, total or near total, with laparospic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43286", "type": "DRG" } ],"standard_charges":[{"minimum":4308.1900,"maximum":4308.1900,"gross_charge":4308.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4308.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagectomy, total or near total, with thoracospic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparospic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngopastrostomy or esophagogastrotomy","code_information":[ { "code": "43288", "type": "DRG" } ],"standard_charges":[{"minimum":5160.8200,"maximum":5160.8200,"gross_charge":5160.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5160.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5076.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastric fundoplasty partial or complete; laparotomy","code_information":[ { "code": "43327", "type": "DRG" } ],"standard_charges":[{"minimum":1141.5300,"maximum":1141.5300,"gross_charge":1141.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1141.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy with directed placement of percutaneous gastrostomy tube","code_information":[ { "code": "43246", "type": "DRG" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":276.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with band ligation of esophageal\/gastric varices","code_information":[ { "code": "43244", "type": "DRG" } ],"standard_charges":[{"minimum":336.8000,"maximum":336.8000,"gross_charge":336.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed","code_information":[ { "code": "43235", "type": "DRG" } ],"standard_charges":[{"minimum":169.3700,"maximum":169.3700,"gross_charge":169.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with biopsy, single or multiple","code_information":[ { "code": "43239", "type": "DRG" } ],"standard_charges":[{"minimum":188.1600,"maximum":188.1600,"gross_charge":188.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":188.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":191.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with control of bleeding, any method","code_information":[ { "code": "43255", "type": "DRG" } ],"standard_charges":[{"minimum":270.7500,"maximum":270.7500,"gross_charge":270.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":270.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with dilation of gastric\/duodenal stricture(s)","code_information":[ { "code": "43245", "type": "DRG" } ],"standard_charges":[{"minimum":238.1000,"maximum":238.1000,"gross_charge":238.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire","code_information":[ { "code": "43248", "type": "DRG" } ],"standard_charges":[{"minimum":229.0500,"maximum":229.0500,"gross_charge":229.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with placement of an endoscopic stent","code_information":[ { "code": "43266", "type": "DRG" } ],"standard_charges":[{"minimum":294.5200,"maximum":294.5200,"gross_charge":294.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with removal of foreign body(s)","code_information":[ { "code": "43247", "type": "DRG" } ],"standard_charges":[{"minimum":239.5100,"maximum":239.5100,"gross_charge":239.5100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":239.5100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagogastroduodenoscopy, with transendoscopic balloon dilation of the esophagus (less than 30 mm in diameter)","code_information":[ { "code": "43249", "type": "DRG" } ],"standard_charges":[{"minimum":208.3300,"maximum":208.3300,"gross_charge":208.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagomyotomy (heller type); thoracic approach","code_information":[ { "code": "43331", "type": "DRG" } ],"standard_charges":[{"minimum":1821.9700,"maximum":1821.9700,"gross_charge":1821.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1821.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, flexible, transoral, with insertion of guide wire followed by passage of dilator(s) over guide wire","code_information":[ { "code": "43226", "type": "DRG" } ],"standard_charges":[{"minimum":271.5200,"maximum":271.5200,"gross_charge":271.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":271.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, flexible, transoral, with removal of foreign body(s)","code_information":[ { "code": "43215", "type": "DRG" } ],"standard_charges":[{"minimum":192.2100,"maximum":192.2100,"gross_charge":192.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":192.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, flexible, transoral, with transendoscopic balloon dilation","code_information":[ { "code": "43220", "type": "DRG" } ],"standard_charges":[{"minimum":160.6200,"maximum":160.6200,"gross_charge":160.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":160.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimens by brushing or washing, when performed","code_information":[ { "code": "43200", "type": "DRG" } ],"standard_charges":[{"minimum":120.2300,"maximum":120.2300,"gross_charge":120.2300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.2300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus, with cricopharyngeal myotomy, includes use of telescope or oparating microscope and repair","code_information":[ { "code": "43180", "type": "DRG" } ],"standard_charges":[{"minimum":767.4800,"maximum":767.4800,"gross_charge":767.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":767.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":754.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen((s) by brushing or washing when preformed","code_information":[ { "code": "43191", "type": "DRG" } ],"standard_charges":[{"minimum":213.8800,"maximum":213.8800,"gross_charge":213.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, with balloon dilation (less than 30mm diameter)","code_information":[ { "code": "43195", "type": "DRG" } ],"standard_charges":[{"minimum":254.2400,"maximum":254.2400,"gross_charge":254.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":254.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, with biopsy, single or multiple","code_information":[ { "code": "43202", "type": "DRG" } ],"standard_charges":[{"minimum":140.4500,"maximum":140.4500,"gross_charge":140.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagoscopy, with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed","code_information":[ { "code": "43212", "type": "DRG" } ],"standard_charges":[{"minimum":255.8600,"maximum":255.8600,"gross_charge":255.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagostomy, fistulization of esophagus, external; cervical approach","code_information":[ { "code": "43352", "type": "DRG" } ],"standard_charges":[{"minimum":1456.3100,"maximum":1456.3100,"gross_charge":1456.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1456.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode(s) placement, recording, analysis and interpretation","code_information":[ { "code": "91034", "type": "DRG" } ],"standard_charges":[{"minimum":268.9700,"maximum":268.9700,"gross_charge":268.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Estrogens; Total","code_information":[ { "code": "82672", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel Polter Suture 2-0","code_information":[ { "code": "270000429", "type": "DRG" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel SH Polter Suture 2-0","code_information":[ { "code": "270000431", "type": "DRG" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000437", "type": "DRG" } ],"standard_charges":[{"minimum":46.0800,"maximum":46.0800,"gross_charge":46.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000439", "type": "DRG" } ],"standard_charges":[{"minimum":33.4700,"maximum":33.4700,"gross_charge":46.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000441", "type": "DRG" } ],"standard_charges":[{"minimum":149.1100,"maximum":149.1100,"gross_charge":46.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethibond Excel V-7 Polter Suture","code_information":[ { "code": "270000443", "type": "DRG" } ],"standard_charges":[{"minimum":178.9300,"maximum":178.9300,"gross_charge":178.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Endo-Surgery Linear Cutter","code_information":[ { "code": "3018401", "type": "DRG" } ],"standard_charges":[{"minimum":161.0000,"maximum":161.0000,"gross_charge":161.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Endo-Surgery Proximate Linear","code_information":[ { "code": "270001209", "type": "DRG" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":86.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Endo-Surgery Reloadable","code_information":[ { "code": "270001217", "type": "DRG" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001211", "type": "DRG" } ],"standard_charges":[{"minimum":93.2200,"maximum":93.2200,"gross_charge":93.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001213", "type": "DRG" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":93.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Enseal X1 Shears Integrated 25","code_information":[ { "code": "270000445", "type": "DRG" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethicon Harmonic 1,100 Shears","code_information":[ { "code": "3019606", "type": "DRG" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethosuximide","code_information":[ { "code": "80168", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ethylene Glycol","code_information":[ { "code": "82693", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evera MRI XT DR SureScan DDMB1D1","code_information":[ { "code": "2800870", "type": "DRG" } ],"standard_charges":[{"minimum":21966.0000,"maximum":21966.0000,"gross_charge":21966.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Delivery Catheter System","code_information":[ { "code": "270001219", "type": "DRG" } ],"standard_charges":[{"minimum":2240.0000,"maximum":2240.0000,"gross_charge":2240.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Delivery System 34 mm","code_information":[ { "code": "270001221", "type": "DRG" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Loading System 23-29mm","code_information":[ { "code": "270000459", "type": "DRG" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Loading System 34mm","code_information":[ { "code": "270001357", "type": "DRG" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020638", "type": "DRG" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020639", "type": "DRG" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020640", "type": "DRG" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020641", "type": "DRG" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision brancial cleft cyst or vestige, confined to skin and subcutaneous tissues","code_information":[ { "code": "42810", "type": "DRG" } ],"standard_charges":[{"minimum":401.9100,"maximum":401.9100,"gross_charge":401.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision chest wall tumor involving rib, with plastic reconstruction; without mediastinal lymphadenectomy","code_information":[ { "code": "21602", "type": "DRG" } ],"standard_charges":[{"minimum":2105.1100,"maximum":2105.1100,"gross_charge":2105.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2105.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision Foreign Body, foot; deep","code_information":[ { "code": "28192", "type": "DRG" } ],"standard_charges":[{"minimum":438.1000,"maximum":438.1000,"gross_charge":438.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":438.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision Ganglion, wrist (dorsal or volar); primary","code_information":[ { "code": "25111", "type": "DRG" } ],"standard_charges":[{"minimum":461.5700,"maximum":461.5700,"gross_charge":461.5700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.5700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of an infected graft; neck","code_information":[ { "code": "35901", "type": "DRG" } ],"standard_charges":[{"minimum":655.1300,"maximum":655.1300,"gross_charge":655.1300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":655.1300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of chest wall tumor including\/involving rib(s)","code_information":[ { "code": "21601", "type": "DRG" } ],"standard_charges":[{"minimum":1579.9400,"maximum":1579.9400,"gross_charge":1579.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1579.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1606.1500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of coarctation of the aorta, with or without associated patent ductus arteriosus, with direct anastomosis","code_information":[ { "code": "33840", "type": "DRG" } ],"standard_charges":[{"minimum":1710.6000,"maximum":1710.6000,"gross_charge":1710.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1710.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1682.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of intracardiac tumor, resection with cardiopulmonary bypass","code_information":[ { "code": "33120", "type": "DRG" } ],"standard_charges":[{"minimum":2860.9600,"maximum":2860.9600,"gross_charge":2860.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2860.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2814.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of lesion, esophagus with primary repair; thoracic or abdominal approach","code_information":[ { "code": "43101", "type": "DRG" } ],"standard_charges":[{"minimum":1370.8900,"maximum":1370.8900,"gross_charge":1370.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1370.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot","code_information":[ { "code": "28090", "type": "DRG" } ],"standard_charges":[{"minimum":437.2200,"maximum":437.2200,"gross_charge":437.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":430.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":437.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of rib, partial","code_information":[ { "code": "21600", "type": "DRG" } ],"standard_charges":[{"minimum":788.8200,"maximum":788.8200,"gross_charge":788.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":788.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of synovial cyst of popliteal space (Baker's Cyst)","code_information":[ { "code": "27345", "type": "DRG" } ],"standard_charges":[{"minimum":684.4700,"maximum":684.4700,"gross_charge":684.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":684.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision of tracheal tumor or carcinoma; cervical","code_information":[ { "code": "31785", "type": "DRG" } ],"standard_charges":[{"minimum":1502.9300,"maximum":1502.9300,"gross_charge":1502.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1502.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision tracheal stenosis and anastomosis; cervical","code_information":[ { "code": "31780", "type": "DRG" } ],"standard_charges":[{"minimum":1651.2700,"maximum":1651.2700,"gross_charge":1651.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1651.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia","code_information":[ { "code": "11420", "type": "DRG" } ],"standard_charges":[{"minimum":115.9300,"maximum":115.9300,"gross_charge":115.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less","code_information":[ { "code": "11400", "type": "DRG" } ],"standard_charges":[{"minimum":117.2900,"maximum":117.2900,"gross_charge":117.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Exploratory","code_information":[ { "code": "44910", "type": "DRG" } ],"standard_charges":[{"minimum":1286.1000,"maximum":1286.1000,"gross_charge":1286.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Exploratory Laparotomy, exploratory celiotomy with or without biopsy(s)","code_information":[ { "code": "49000", "type": "DRG" } ],"standard_charges":[{"minimum":1076.5300,"maximum":1076.5300,"gross_charge":1076.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1076.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Extractable nuclear antigen, antibody to, any method, each antibody","code_information":[ { "code": "86235", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Eye Acu.Dispo.Cautery High Temperature","code_information":[ { "code": "270001223", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"F2 gene analysis 20210G>A variant","code_information":[ { "code": "81240", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"F5 gene analysis, Leiden variant","code_information":[ { "code": "81241", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"F9 full gene sequence","code_information":[ { "code": "81238", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fat or lipids, feces; qualitatives","code_information":[ { "code": "82705", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fat or lipids, feces; qualititative","code_information":[ { "code": "82710", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fatty acids, nonesterified","code_information":[ { "code": "82725", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Felbamate","code_information":[ { "code": "80167", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Femoral Angiography (Bundle)","code_information":[ { "code": "270000469", "type": "DRG" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Femoral Artery Catheter Set 4.0","code_information":[ { "code": "270000471", "type": "DRG" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fenestrated Bipolar Forceps","code_information":[ { "code": "3021118", "type": "DRG" } ],"standard_charges":[{"minimum":4116.0000,"maximum":4116.0000,"gross_charge":4116.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ferritin","code_information":[ { "code": "82728", "type": "DRG" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fetal congenital abnormalities, biochemical assys of three proteins, utilizing maternal serum, algorithm reported as a risk score","code_information":[ { "code": "81509", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative","code_information":[ { "code": "82731", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative","code_information":[ { "code": "85379", "type": "DRG" } ],"standard_charges":[{"minimum":42.2200,"maximum":42.2200,"gross_charge":42.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fibrin Degradation Products, D Dimer; qualitative or semiquantitative","code_information":[ { "code": "85378", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fibrin Degradation Products; agglutination slide, semiquantitative","code_information":[ { "code": "85362", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fibrinogen; activity","code_information":[ { "code": "85384", "type": "DRG" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Finishing Wire Supportrak Model 6668","code_information":[ { "code": "270000473", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fixation Tool (Model 6616)","code_information":[ { "code": "270000475", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Flexor Check-Flo Introducer Set 8Fr","code_information":[ { "code": "270000477", "type": "DRG" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":364.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fluid Trap Minivac Smk Evac","code_information":[ { "code": "3019903", "type": "DRG" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fluorescent noninfectious agent antibody; screen, each antibody","code_information":[ { "code": "86255", "type": "DRG" } ],"standard_charges":[{"minimum":103.8400,"maximum":103.8400,"gross_charge":103.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":103.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"FMR1 gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81243", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"FOBTransNeedleAspiration","code_information":[ { "code": "31639", "type": "DRG" } ],"standard_charges":[{"minimum":250.8900,"maximum":250.8900,"gross_charge":250.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fogarty #2F","code_information":[ { "code": "270001227", "type": "DRG" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fogarty #3F","code_information":[ { "code": "270001229", "type": "DRG" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fogarty #4F","code_information":[ { "code": "270001231", "type": "DRG" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fogarty #5F","code_information":[ { "code": "270001233", "type": "DRG" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fogarty #6F","code_information":[ { "code": "270001235", "type": "DRG" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Folic acid; serum","code_information":[ { "code": "82746", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Freestyle 995 Bioprosthesis Aortic","code_information":[ { "code": "2702926", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fresh frozen plasma (single donor) each unit requisitioned to be AB positive","code_information":[ { "code": "P9017", "type": "DRG" } ],"standard_charges":[{"minimum":85.0000,"maximum":85.0000,"gross_charge":85.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fresh frozen plasma between 8-24 hours of collection, each unit","code_information":[ { "code": "P9059", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fresh frozen plasma, thawing, each unit","code_information":[ { "code": "86927", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Full access underbody 3M Bair hugger","code_information":[ { "code": "270000513", "type": "DRG" } ],"standard_charges":[{"minimum":37.1000,"maximum":37.1000,"gross_charge":37.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Full Access Underbody Adult","code_information":[ { "code": "270000515", "type": "DRG" } ],"standard_charges":[{"minimum":48.3700,"maximum":48.3700,"gross_charge":48.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Fullthickness graft free incluiding direct closure of donor site; trunk; 20 sq cm or less","code_information":[ { "code": "15200", "type": "DRG" } ],"standard_charges":[{"minimum":929.9600,"maximum":929.9600,"gross_charge":929.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":929.9600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gabapentin, whole blood, serum or plasma","code_information":[ { "code": "80171", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Galactose 1 Phosphate uridyl transferase; quantitative","code_information":[ { "code": "82775", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gallant HF CRT-D","code_information":[ { "code": "3019745", "type": "DRG" } ],"standard_charges":[{"minimum":16258.2000,"maximum":16258.2000,"gross_charge":16258.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gammaglobulin; IgA, IgD, IgG, IgM, each","code_information":[ { "code": "82784", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO16","code_information":[ { "code": "82803", "type": "DRG" } ],"standard_charges":[{"minimum":52.0000,"maximum":52.0000,"gross_charge":52.0000,"setting":"inpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrectomy, total; with esophagoenterostomy","code_information":[ { "code": "43620", "type": "DRG" } ],"standard_charges":[{"minimum":2717.8500,"maximum":2717.8500,"gross_charge":2717.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2717.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrointestinal Pathogen; includes multiplex reserve transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets","code_information":[ { "code": "87507", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrostomy Feeding Tube 12Fr","code_information":[ { "code": "270001237", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrostomy Feeding Tube 24 Fr","code_information":[ { "code": "270001239", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrostomy Tube Feeding 14Fr","code_information":[ { "code": "2770971", "type": "DRG" } ],"standard_charges":[{"minimum":75.1800,"maximum":75.1800,"gross_charge":75.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrostomy, open; without construction of gastric tube","code_information":[ { "code": "43830", "type": "DRG" } ],"standard_charges":[{"minimum":971.6400,"maximum":971.6400,"gross_charge":971.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":971.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gastrotomy, with exploration or foreign body removal","code_information":[ { "code": "43500", "type": "DRG" } ],"standard_charges":[{"minimum":1103.3800,"maximum":1103.3800,"gross_charge":1103.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1103.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GDWR CGRXT190HS Cougar XT 5PK 190 ST","code_information":[ { "code": "2750403", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gentamicin","code_information":[ { "code": "80170", "type": "DRG" } ],"standard_charges":[{"minimum":36.4000,"maximum":36.4000,"gross_charge":36.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gliadin antibody, each immunoglobulin Ig class","code_information":[ { "code": "86258", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glide Scope BFlex 3.8","code_information":[ { "code": "3021309", "type": "DRG" } ],"standard_charges":[{"minimum":442.4000,"maximum":442.4000,"gross_charge":442.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glide Sheath Basic 5fr\/100cm","code_information":[ { "code": "2820986", "type": "DRG" } ],"standard_charges":[{"minimum":110.6000,"maximum":110.6000,"gross_charge":110.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glidecath Angled Taper 5Fr\/100cm","code_information":[ { "code": "270000517", "type": "DRG" } ],"standard_charges":[{"minimum":61.1700,"maximum":61.1700,"gross_charge":61.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GlideLight Laser Sheath Size 14F","code_information":[ { "code": "270000519", "type": "DRG" } ],"standard_charges":[{"minimum":3391.5000,"maximum":3391.5000,"gross_charge":3391.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GlideLight Laser Sheath, 12F","code_information":[ { "code": "270000521", "type": "DRG" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GlideLight Laser Sheath, 16F","code_information":[ { "code": "270000523", "type": "DRG" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GLIDESHEAT Hydrophilic Coated","code_information":[ { "code": "270000525", "type": "DRG" } ],"standard_charges":[{"minimum":92.4000,"maximum":92.4000,"gross_charge":92.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glideware Advantage","code_information":[ { "code": "270000527", "type": "DRG" } ],"standard_charges":[{"minimum":301.0000,"maximum":301.0000,"gross_charge":301.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glidewire Cath. Exchange","code_information":[ { "code": "270000529", "type": "DRG" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glucagon","code_information":[ { "code": "82943", "type": "DRG" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glucose Tolerance test (GTT), 3 specimens (including glucose)","code_information":[ { "code": "82951", "type": "DRG" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glucose, body fluid, other than blood","code_information":[ { "code": "82945", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glucose; quantitative, blood","code_information":[ { "code": "82947", "type": "DRG" } ],"standard_charges":[{"minimum":48.0100,"maximum":48.0100,"gross_charge":48.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glucose-6-Phosphate Dehydrogen (G6PD); quantitative","code_information":[ { "code": "82955", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glutamyltransferase, gamma","code_information":[ { "code": "82977", "type": "DRG" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Glycated protein","code_information":[ { "code": "82985", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gold Probe 350 cm Electrical Connector","code_information":[ { "code": "270001241", "type": "DRG" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gonadotropin, chorionic (hCG); quantitative","code_information":[ { "code": "84702", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gonadotropin, chorionic; Qualitative","code_information":[ { "code": "84703", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gonadotropin; follicle stimulating hormone (FSH)","code_information":[ { "code": "83001", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gonadotropin; luteinizing hormone (LH)","code_information":[ { "code": "83002", "type": "DRG" } ],"standard_charges":[{"minimum":30.5500,"maximum":30.5500,"gross_charge":30.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gore Acuaseal Cardiovascular Patch","code_information":[ { "code": "2720027", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gore Acuseal Cardiovascular Patch","code_information":[ { "code": "2720930", "type": "DRG" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "3021048", "type": "DRG" } ],"standard_charges":[{"minimum":634.2000,"maximum":634.2000,"gross_charge":634.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "8017780", "type": "DRG" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":634.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gore Dualmesh Biomaterial 26.0 cm x","code_information":[ { "code": "2710811", "type": "DRG" } ],"standard_charges":[{"minimum":2433.2000,"maximum":2433.2000,"gross_charge":2433.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE EXCLUDER AAA Endoprosthesis","code_information":[ { "code": "3019130", "type": "DRG" } ],"standard_charges":[{"minimum":11603.2000,"maximum":11603.2000,"gross_charge":11603.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE Excluder Conformable AAA","code_information":[ { "code": "3021206", "type": "DRG" } ],"standard_charges":[{"minimum":14074.2000,"maximum":14074.2000,"gross_charge":14074.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE PRECLUDE Pericardial Membrane","code_information":[ { "code": "2700226", "type": "DRG" } ],"standard_charges":[{"minimum":462.0000,"maximum":462.0000,"gross_charge":462.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE PROPATEN Vascular Graft","code_information":[ { "code": "2750234", "type": "DRG" } ],"standard_charges":[{"minimum":1939.0000,"maximum":1939.0000,"gross_charge":1939.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE-TEX CV-3","code_information":[ { "code": "270001245", "type": "DRG" } ],"standard_charges":[{"minimum":947.8000,"maximum":947.8000,"gross_charge":947.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Gore-Tex Stretch Vascular Graft 6 mm x","code_information":[ { "code": "2710897", "type": "DRG" } ],"standard_charges":[{"minimum":1050.0000,"maximum":1050.0000,"gross_charge":1050.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE-TEX Suture CV-5","code_information":[ { "code": "270001247", "type": "DRG" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GORE-TEX Suture CV-6","code_information":[ { "code": "270001249", "type": "DRG" } ],"standard_charges":[{"minimum":33.9100,"maximum":33.9100,"gross_charge":33.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GOR-TEX CV-4 Suture","code_information":[ { "code": "270001243", "type": "DRG" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Graft Sizers Size 05 mm- 24 mm","code_information":[ { "code": "270001251", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Graft Sizers Size 24 mm- 38 mm","code_information":[ { "code": "270000533", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Growth Hormone, human (HGH)","code_information":[ { "code": "83003", "type": "DRG" } ],"standard_charges":[{"minimum":32.2000,"maximum":32.2000,"gross_charge":32.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Guidewire GWBC30 Confida 29L 3YSL","code_information":[ { "code": "3017622", "type": "DRG" } ],"standard_charges":[{"minimum":218.4000,"maximum":218.4000,"gross_charge":218.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Guiding Catheter 6F XB 3.5 100cm","code_information":[ { "code": "270000535", "type": "DRG" } ],"standard_charges":[{"minimum":147.0000,"maximum":147.0000,"gross_charge":147.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"GW N141802 NITREX V03","code_information":[ { "code": "270000685", "type": "DRG" } ],"standard_charges":[{"minimum":105.0000,"maximum":105.0000,"gross_charge":105.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Haemophilus Influenza","code_information":[ { "code": "86684", "type": "DRG" } ],"standard_charges":[{"minimum":245.1400,"maximum":245.1400,"gross_charge":245.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Harmonic 1100 Shears Integrated Hand","code_information":[ { "code": "270000539", "type": "DRG" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Harmonic Blue Hand Piece and Blue Test","code_information":[ { "code": "270000541", "type": "DRG" } ],"standard_charges":[{"minimum":27328.0000,"maximum":27328.0000,"gross_charge":27328.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Harmonic Focus Shears + Adaptative","code_information":[ { "code": "270001253", "type": "DRG" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Harmonic HD 1000i Shears Integrated","code_information":[ { "code": "270000543", "type": "DRG" } ],"standard_charges":[{"minimum":774.2000,"maximum":774.2000,"gross_charge":774.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Harmony Delivery Catheter System 25 Fr","code_information":[ { "code": "3020666", "type": "DRG" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Heart transplant, with or without recipient cardiectomy","code_information":[ { "code": "33945", "type": "DRG" } ],"standard_charges":[{"minimum":6535.4200,"maximum":6535.4200,"gross_charge":6535.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6535.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Heavy Metals; qualitative, any number of analytes","code_information":[ { "code": "83015", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Helicobacter Pylori","code_information":[ { "code": "86677", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Helicobacter pylori stool","code_information":[ { "code": "87338", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope","code_information":[ { "code": "83013", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hema-Carotid Vascular Patch Ultrathin","code_information":[ { "code": "2700854", "type": "DRG" } ],"standard_charges":[{"minimum":112.0000,"maximum":112.0000,"gross_charge":112.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemashield Woven Double Velour","code_information":[ { "code": "2700908", "type": "DRG" } ],"standard_charges":[{"minimum":996.1000,"maximum":996.1000,"gross_charge":996.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemashield Knitted Double 2_x001D_ X 6\"","code_information":[ { "code": "2710995", "type": "DRG" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":868.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemoconcentrator Perfusion Service","code_information":[ { "code": "2740020", "type": "DRG" } ],"standard_charges":[{"minimum":126.0000,"maximum":126.0000,"gross_charge":126.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemoglobin Fractionation and quantitation; electrophoresis","code_information":[ { "code": "83020", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemoglobin S, per test","code_information":[ { "code": "83021", "type": "DRG" } ],"standard_charges":[{"minimum":62.5000,"maximum":62.5000,"gross_charge":62.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemoglobin; glycosilated (A1C)","code_information":[ { "code": "83036", "type": "DRG" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemoglobin; Methemoglobin, quantitative","code_information":[ { "code": "83050", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemolysins and agglutinin; auto, screen, each","code_information":[ { "code": "86940", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hemolysins and agglutinins; Incubated","code_information":[ { "code": "86941", "type": "DRG" } ],"standard_charges":[{"minimum":89.5000,"maximum":89.5000,"gross_charge":89.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Heparin assay","code_information":[ { "code": "85520", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatic function panel","code_information":[ { "code": "80076", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis A Antibody","code_information":[ { "code": "86708", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis A Antibody IgM antibody","code_information":[ { "code": "86709", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis B Core Antibody Total","code_information":[ { "code": "86704", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis B Surface antigen","code_information":[ { "code": "87340", "type": "DRG" } ],"standard_charges":[{"minimum":50.4000,"maximum":50.4000,"gross_charge":50.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis B Surface Antigen neutralization","code_information":[ { "code": "87341", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis B Virus, quantification","code_information":[ { "code": "87517", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis BE Antibody","code_information":[ { "code": "86707", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis BE Antigen","code_information":[ { "code": "87350", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis C Antibody","code_information":[ { "code": "86803", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis C Quantification, includes reverse transcription when performed","code_information":[ { "code": "87522", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis C virus","code_information":[ { "code": "87902", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hepatitis Delta agent","code_information":[ { "code": "86692", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Herpes Simplex Virus; amplified probe technique","code_information":[ { "code": "87529", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Herpes Simplex, non-specific type test","code_information":[ { "code": "86694", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Heterophile antibodies; screening","code_information":[ { "code": "86308", "type": "DRG" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":7.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hex Wrench Model","code_information":[ { "code": "270000545", "type": "DRG" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Histoplasma","code_information":[ { "code": "86698", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Histoplasma capsulatum","code_information":[ { "code": "87385", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hi-Torque Whisper MS Guide Wire","code_information":[ { "code": "270000547", "type": "DRG" } ],"standard_charges":[{"minimum":126.3500,"maximum":126.3500,"gross_charge":126.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV 1 and 2 Antibody","code_information":[ { "code": "86703", "type": "DRG" } ],"standard_charges":[{"minimum":5.8200,"maximum":5.8200,"gross_charge":5.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV 1 Antibody","code_information":[ { "code": "86701", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV 1 antigens, with HIV-1 and HIV2 Antibodies, single result","code_information":[ { "code": "87389", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV 1, quantification, includes reverse transcription when performed","code_information":[ { "code": "87536", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV 14","code_information":[ { "code": "87390", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV-1, amplified probe technique, includes reverse transcription when performed","code_information":[ { "code": "87535", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HIV-1, reverse transcriptase and protease regions","code_information":[ { "code": "87901", "type": "DRG" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HLA Class I and II typing, low resolution assessment, HLA-A, -B, -C, -DRB1\/3\/4\/5, and -DQB11","code_information":[ { "code": "81370", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HLA Class I tiping, high resolution, complete, one allele or allele group, each","code_information":[ { "code": "81381", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HLA typing; A, B or C, single antigen","code_information":[ { "code": "86812", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Homocysteine","code_information":[ { "code": "83090", "type": "DRG" } ],"standard_charges":[{"minimum":203.0000,"maximum":203.0000,"gross_charge":203.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HTLV I","code_information":[ { "code": "86687", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HTLV or HIV antibody, confirmatory test","code_information":[ { "code": "86689", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"HTT gene analysis; evaluation to detect abnormal, alleles","code_information":[ { "code": "81271", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Human Papillomavirus, High Risk types","code_information":[ { "code": "87624", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Human to human leukocyte antigens (HLA), solid phase assays; antibody identification by qualitative panel using complete HLA phenotypes, HLA class I","code_information":[ { "code": "86830", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hydrophilic Coated Spring Coil Guide","code_information":[ { "code": "270000551", "type": "DRG" } ],"standard_charges":[{"minimum":187.6000,"maximum":187.6000,"gross_charge":187.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hydrophilic Guidewire 0.035in x 180cm","code_information":[ { "code": "270000553", "type": "DRG" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hydroxycorticosteroids, 17-","code_information":[ { "code": "83491", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hydroxyindolacetic acid, 5-","code_information":[ { "code": "83497", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hydroxyprogesterone, 17-d","code_information":[ { "code": "83498", "type": "DRG" } ],"standard_charges":[{"minimum":260.6200,"maximum":260.6200,"gross_charge":260.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":260.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Hysteroscopy, surgical; with endometrial ablation","code_information":[ { "code": "58563", "type": "DRG" } ],"standard_charges":[{"minimum":342.5900,"maximum":342.5900,"gross_charge":342.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ICD Fortify DR","code_information":[ { "code": "2820146", "type": "DRG" } ],"standard_charges":[{"minimum":18998.0000,"maximum":18998.0000,"gross_charge":18998.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ICD-VR DVFC3D1 Visia AF MRI S US DF1","code_information":[ { "code": "3017510", "type": "DRG" } ],"standard_charges":[{"minimum":11175.0000,"maximum":11175.0000,"gross_charge":11175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"IGA Testing","code_information":[ { "code": "NRL40", "type": "DRG" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method","code_information":[ { "code": "83516", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative, by radioimmunoassay","code_information":[ { "code": "83519", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified","code_information":[ { "code": "83520", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Immunofixation electrophoresis; serum","code_information":[ { "code": "86334", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Immunoglobulin E (IgE)","code_information":[ { "code": "82785", "type": "DRG" } ],"standard_charges":[{"minimum":12.6000,"maximum":12.6000,"gross_charge":12.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision & Drainage Forearm and\/or wrist - bursa","code_information":[ { "code": "25031", "type": "DRG" } ],"standard_charges":[{"minimum":530.2200,"maximum":530.2200,"gross_charge":530.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision & Drainage leg or ankle deep abcess or hematoma","code_information":[ { "code": "27603", "type": "DRG" } ],"standard_charges":[{"minimum":551.8800,"maximum":551.8800,"gross_charge":551.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":551.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision & Drainage of an upper arm or elbow area; deep abscess or hematoma","code_information":[ { "code": "23930", "type": "DRG" } ],"standard_charges":[{"minimum":304.7400,"maximum":304.7400,"gross_charge":304.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision & Drainage of Hematoma, seroma or fluid collection","code_information":[ { "code": "10140", "type": "DRG" } ],"standard_charges":[{"minimum":164.0500,"maximum":164.0500,"gross_charge":164.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":166.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision & Drainage, bursa, foot","code_information":[ { "code": "28001", "type": "DRG" } ],"standard_charges":[{"minimum":195.4300,"maximum":195.4300,"gross_charge":195.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision and drainage of abcess; complicated or multiple","code_information":[ { "code": "10061", "type": "DRG" } ],"standard_charges":[{"minimum":259.7600,"maximum":259.7600,"gross_charge":259.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision and drainage of abcess; simple or single","code_information":[ { "code": "10060", "type": "DRG" } ],"standard_charges":[{"minimum":148.1100,"maximum":148.1100,"gross_charge":148.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision and drainage, complex, postoperative wound infection","code_information":[ { "code": "10180", "type": "DRG" } ],"standard_charges":[{"minimum":251.6100,"maximum":251.6100,"gross_charge":251.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.6100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision and drainage, deep abcess or hematoma, soft tissues of neck or thorax","code_information":[ { "code": "21501", "type": "DRG" } ],"standard_charges":[{"minimum":478.7700,"maximum":478.7700,"gross_charge":478.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Incision and removal of foreing body, subcutaneous tissues; simple","code_information":[ { "code": "10120", "type": "DRG" } ],"standard_charges":[{"minimum":146.6900,"maximum":146.6900,"gross_charge":146.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Infectious agent antiguen detection by immunofluorescent technique; adnovirus","code_information":[ { "code": "87260", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Infectiuos agent detection by nuleic acid DNA PCR not otherwise specified; amipified probe technique, each organism","code_information":[ { "code": "87798", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Infectiuos agent detection by nuleic acid DNA PCR not otherwise specified; quantification, each organism","code_information":[ { "code": "87799", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare 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separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Infectius agent antigen detention by immunoassay with direct optical observation; not otherwise specified","code_information":[ { "code": "87899", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold 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B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Infecttiuos agent phenotype analysis by 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be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"INFINITI Angiographic Catheter (PIG)","code_information":[ { "code": "270000557", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"INFINITI Diagstic Catheter (PIG)","code_information":[ { "code": "270000559", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed 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{ "code": "270000561", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple 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Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"INFINITY Diagstic Catheter JR-4","code_information":[ { "code": "270000565", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Influenza","code_information":[ { "code": "87804", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S 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separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and mutiplex amplified probe technique, first 2 types or sub types","code_information":[ { "code": "87502", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ingevity + 7841 52CM","code_information":[ { "code": "3017220", "type": "DRG" } ],"standard_charges":[{"minimum":819.0000,"maximum":819.0000,"gross_charge":819.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ingevity+ 7840 45CM","code_information":[ { "code": "3020156", "type": "DRG" } ],"standard_charges":[{"minimum":805.0000,"maximum":805.0000,"gross_charge":805.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography","code_information":[ { "code": "93567", "type": "DRG" } ],"standard_charges":[{"minimum":50.3700,"maximum":50.3700,"gross_charge":50.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Injection procedure; lymphangiography","code_information":[ { "code": "38790", "type": "DRG" } ],"standard_charges":[{"minimum":115.4900,"maximum":115.4900,"gross_charge":115.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Injection, dipyridamole, per 10 mg","code_information":[ { "code": "J1245", "type": "DRG" } ],"standard_charges":[{"minimum":30.8000,"maximum":30.8000,"gross_charge":30.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Inpatient Step - Down Unit (For patient in Emergency Room w admission order)","code_information":[ { "code": "160000001", "type": "DRG" } ],"standard_charges":[{"minimum":371.4300,"maximum":400.0000,"gross_charge":371.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a cannula for hemodialysis, other purpose (separe procedure); vein-to-vein","code_information":[ { "code": "36800", "type": "DRG" } ],"standard_charges":[{"minimum":163.2300,"maximum":163.2300,"gross_charge":163.2300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.2300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.9400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a non-tunneled centrally inserted central venous catheter; younger than 5 years of age","code_information":[ { "code": "36556", "type": "DRG" } ],"standard_charges":[{"minimum":116.0200,"maximum":116.0200,"gross_charge":116.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a peripherally inserted central venous access device, with subcutaneous port; younger than five years of age","code_information":[ { "code": "36570", "type": "DRG" } ],"standard_charges":[{"minimum":464.2100,"maximum":464.2100,"gross_charge":464.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator","code_information":[ { "code": "33216", "type": "DRG" } ],"standard_charges":[{"minimum":503.6100,"maximum":503.6100,"gross_charge":503.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":511.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a tunneled centrally inserted central venous access device with a subcutaneous pump","code_information":[ { "code": "36563", "type": "DRG" } ],"standard_charges":[{"minimum":499.6900,"maximum":499.6900,"gross_charge":499.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":499.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a tunneled centrally inserted central venous access device, with subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36560", "type": "DRG" } ],"standard_charges":[{"minimum":534.4900,"maximum":534.4900,"gross_charge":534.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":534.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, younger than five years of age","code_information":[ { "code": "36557", "type": "DRG" } ],"standard_charges":[{"minimum":440.1600,"maximum":440.1600,"gross_charge":440.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of an intra-aortic balloon assist device, percutaneous","code_information":[ { "code": "33967", "type": "DRG" } ],"standard_charges":[{"minimum":346.6300,"maximum":346.6300,"gross_charge":346.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":346.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of epicardial electrode; endoscopic approach","code_information":[ { "code": "33203", "type": "DRG" } ],"standard_charges":[{"minimum":1116.2900,"maximum":1116.2900,"gross_charge":1116.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of epicardial electrode; open incision","code_information":[ { "code": "33202", "type": "DRG" } ],"standard_charges":[{"minimum":1045.1000,"maximum":1045.1000,"gross_charge":1045.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1045.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of indwelling tunneled pleural catheter with cuff","code_information":[ { "code": "32550", "type": "DRG" } ],"standard_charges":[{"minimum":275.1000,"maximum":275.1000,"gross_charge":275.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":275.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radilogical supervision and interpretation, intraprocedural roadmapping, and imaging guidance, when perfomed","code_information":[ { "code": "37191", "type": "DRG" } ],"standard_charges":[{"minimum":299.1000,"maximum":299.1000,"gross_charge":299.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; atrial and ventricular","code_information":[ { "code": "33208", "type": "DRG" } ],"standard_charges":[{"minimum":710.6400,"maximum":710.6400,"gross_charge":710.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":710.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":699.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode; ventricular","code_information":[ { "code": "33207", "type": "DRG" } ],"standard_charges":[{"minimum":645.9000,"maximum":645.9000,"gross_charge":645.9000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":645.9000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of pacemaker pulse generator only; with existing single lead","code_information":[ { "code": "33212", "type": "DRG" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator","code_information":[ { "code": "33225", "type": "DRG" } ],"standard_charges":[{"minimum":629.0900,"maximum":629.0900,"gross_charge":629.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":629.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator","code_information":[ { "code": "33224", "type": "DRG" } ],"standard_charges":[{"minimum":698.1200,"maximum":698.1200,"gross_charge":698.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":698.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion or replacement of permanent implantable defibrillator system, with transvenous lead, single or dual chamber","code_information":[ { "code": "33249", "type": "DRG" } ],"standard_charges":[{"minimum":1230.7800,"maximum":1230.7800,"gross_charge":1230.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1251.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1230.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion or replacement of temporary transvenous single chaber cardiac electrode or pacemaker catheter","code_information":[ { "code": "33210", "type": "DRG" } ],"standard_charges":[{"minimum":219.7700,"maximum":219.7700,"gross_charge":219.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":216.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":614.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insertion, subcutaneous cardiac rhythm monitor, including programming","code_information":[ { "code": "33285", "type": "DRG" } ],"standard_charges":[{"minimum":800.0000,"maximum":800.0000,"gross_charge":800.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021080", "type": "DRG" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021081", "type": "DRG" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insulin antibodies","code_information":[ { "code": "86337", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Insulin Level Total","code_information":[ { "code": "83525", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intensive Care Unit (ICU)","code_information":[ { "code": "201000001", "type": "DRG" } ],"standard_charges":[{"minimum":1199.8000,"maximum":782.0000,"gross_charge":1199.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Aortic ARCH #24mm","code_information":[ { "code": "2760101", "type": "DRG" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711176", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S 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separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711181", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2780000", "type": "DRG" } ],"standard_charges":[{"minimum":821.8000,"maximum":821.8000,"gross_charge":821.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S 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billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Straight #10mm X","code_information":[ { "code": "2711186", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Straight #22mm X","code_information":[ { "code": "2711197", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Knitted Straight #8mm X 40cm","code_information":[ { "code": "2719754", "type": "DRG" } ],"standard_charges":[{"minimum":565.6000,"maximum":565.6000,"gross_charge":565.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven 10 X 30cm Straight","code_information":[ { "code": "2711207", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven 26 x 10cm Straight","code_information":[ { "code": "2711213", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven 28 X 30cm Straight.","code_information":[ { "code": "2711216", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven 30 X 30cm Straight","code_information":[ { "code": "2711226", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2710941", "type": "DRG" } ],"standard_charges":[{"minimum":727.3000,"maximum":727.3000,"gross_charge":727.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2711218", "type": "DRG" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2780608", "type": "DRG" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2781619", "type": "DRG" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"INTERING VASC GRAFT STR TW IR 6mmX80cm","code_information":[ { "code": "2740135", "type": "DRG" } ],"standard_charges":[{"minimum":1659.0000,"maximum":1659.0000,"gross_charge":1659.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Interject (Injection Therapy Needle","code_information":[ { "code": "2810766", "type": "DRG" } ],"standard_charges":[{"minimum":231.0000,"maximum":231.0000,"gross_charge":231.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Interleukin-6 (IL-6)","code_information":[ { "code": "83529", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intra cardiac catheter ablation of artrioventricular node function, atrion ventricular condution for creation of complete heart block, with or without temporary pacemaker placement","code_information":[ { "code": "93650", "type": "DRG" } ],"standard_charges":[{"minimum":791.7400,"maximum":791.7400,"gross_charge":791.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":791.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intra-Aortic Ballon Tray Ready (IABP","code_information":[ { "code": "2704760", "type": "DRG" } ],"standard_charges":[{"minimum":1300.0000,"maximum":1300.0000,"gross_charge":1300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intra-Aortic Balloon Catheter and","code_information":[ { "code": "2721120", "type": "DRG" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intra-atrial pacing","code_information":[ { "code": "93610", "type": "DRG" } ],"standard_charges":[{"minimum":4712.9300,"maximum":4712.9300,"gross_charge":4712.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4712.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intracardiac electrophysiology 3 dimensional mapping","code_information":[ { "code": "93613", "type": "DRG" } ],"standard_charges":[{"minimum":390.2400,"maximum":390.2400,"gross_charge":390.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":390.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intravascular ultrasound during diagnostic evaluation and\/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel","code_information":[ { "code": "37253", "type": "DRG" } ],"standard_charges":[{"minimum":95.8900,"maximum":95.8900,"gross_charge":95.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":95.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intravascular ultrasound during diagnostic evaluation and\/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel","code_information":[ { "code": "37252", "type": "DRG" } ],"standard_charges":[{"minimum":120.5500,"maximum":120.5500,"gross_charge":120.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intraventricular and\/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify the origin of tachycardia","code_information":[ { "code": "93609", "type": "DRG" } ],"standard_charges":[{"minimum":2827.7600,"maximum":2827.7600,"gross_charge":2827.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2827.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"INTRO HLS2507MCN Safe Sheath 7 FR 25CM","code_information":[ { "code": "3020167", "type": "DRG" } ],"standard_charges":[{"minimum":78.4000,"maximum":78.4000,"gross_charge":78.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Introduction of needle or intracatheter, upper or lower extremity artery","code_information":[ { "code": "36140", "type": "DRG" } ],"standard_charges":[{"minimum":121.0200,"maximum":121.0200,"gross_charge":121.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Introduction of needle(s) and\/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct punture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomisis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and repor","code_information":[ { "code": "36901", "type": "DRG" } ],"standard_charges":[{"minimum":228.2600,"maximum":228.2600,"gross_charge":228.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":228.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Intubating Style Adult","code_information":[ { "code": "2709185", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Iron","code_information":[ { "code": "83540", "type": "DRG" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Iron Binding Capacity","code_information":[ { "code": "83550", "type": "DRG" } ],"standard_charges":[{"minimum":18.0000,"maximum":18.0000,"gross_charge":18.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Irradiation of blood product, each unit","code_information":[ { "code": "86945", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"IS-1 (3.2mm) Receptacle Plug","code_information":[ { "code": "270000573", "type": "DRG" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"IS4\/DF4 Connector Sleeve","code_information":[ { "code": "270000575", "type": "DRG" } ],"standard_charges":[{"minimum":9139.2000,"maximum":9139.2000,"gross_charge":9139.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"IS4\/DF4 Plug","code_information":[ { "code": "2730053", "type": "DRG" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Islet cell antibody","code_information":[ { "code": "86341", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ISOFLEX Pacing lead","code_information":[ { "code": "2820699", "type": "DRG" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Isolation","code_information":[ { "code": "164000005", "type": "DRG" } ],"standard_charges":[{"minimum":410.0000,"maximum":410.0000,"gross_charge":410.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"John Cunningham virus Antibody","code_information":[ { "code": "86711", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Jot Dx Insertable Cardiac Monitor","code_information":[ { "code": "2750479", "type": "DRG" } ],"standard_charges":[{"minimum":3500.0000,"maximum":3500.0000,"gross_charge":3500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ketones body(s); qualitative","code_information":[ { "code": "82009", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ketones body(s); quantitative","code_information":[ { "code": "82010", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ketosteroids, 17- (17-KS); total","code_information":[ { "code": "83586", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Konect Resilia Aortic Valved Conduit","code_information":[ { "code": "3020098", "type": "DRG" } ],"standard_charges":[{"minimum":15540.0000,"maximum":15540.0000,"gross_charge":15540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lactate","code_information":[ { "code": "83605", "type": "DRG" } ],"standard_charges":[{"minimum":76.0000,"maximum":76.0000,"gross_charge":76.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":79.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lactate Dehydrogenase (LD), (LDH)","code_information":[ { "code": "83615", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lamotrigine","code_information":[ { "code": "80175", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopic Tubing, 6.5mm, With Lure","code_information":[ { "code": "3019900", "type": "DRG" } ],"standard_charges":[{"minimum":875.0000,"maximum":875.0000,"gross_charge":875.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":875.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopic, abdomen, peritoneum, and omentum, diagnostic, with or without specimen collection of specimen(s) by brushing or washing","code_information":[ { "code": "49320", "type": "DRG" } ],"standard_charges":[{"minimum":463.3700,"maximum":463.3700,"gross_charge":463.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":463.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopic, surgical, esophagomyotomy with fundoplasty, when performed","code_information":[ { "code": "43279", "type": "DRG" } ],"standard_charges":[{"minimum":1758.3200,"maximum":1758.3200,"gross_charge":1758.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopic, surgical; repair of an initial inguinal hernia","code_information":[ { "code": "49650", "type": "DRG" } ],"standard_charges":[{"minimum":611.7600,"maximum":611.7600,"gross_charge":611.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":611.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, enterolysis","code_information":[ { "code": "44180", "type": "DRG" } ],"standard_charges":[{"minimum":1691.3800,"maximum":1691.3800,"gross_charge":1691.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1691.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, appendectomy","code_information":[ { "code": "44970", "type": "DRG" } ],"standard_charges":[{"minimum":847.3500,"maximum":847.3500,"gross_charge":847.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":847.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device, including cruroplasty when performed","code_information":[ { "code": "43284", "type": "DRG" } ],"standard_charges":[{"minimum":902.2400,"maximum":902.2400,"gross_charge":902.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":902.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, esophagogastric fundoplasty","code_information":[ { "code": "43280", "type": "DRG" } ],"standard_charges":[{"minimum":1480.9600,"maximum":1480.9600,"gross_charge":1480.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1480.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1505.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, mobilization (take-down) of the splenic flexure performed in conjunction with partial colectomy","code_information":[ { "code": "44213", "type": "DRG" } ],"standard_charges":[{"minimum":256.6100,"maximum":256.6100,"gross_charge":256.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.6100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh","code_information":[ { "code": "43282", "type": "DRG" } ],"standard_charges":[{"minimum":2370.0700,"maximum":2370.0700,"gross_charge":2370.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2370.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh","code_information":[ { "code": "43281", "type": "DRG" } ],"standard_charges":[{"minimum":2104.4800,"maximum":2104.4800,"gross_charge":2104.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2104.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical, splenectomy","code_information":[ { "code": "38120", "type": "DRG" } ],"standard_charges":[{"minimum":1483.6500,"maximum":1483.6500,"gross_charge":1483.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1483.6500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical; colectomy, partial, with anastomosis","code_information":[ { "code": "44204", "type": "DRG" } ],"standard_charges":[{"minimum":2134.0300,"maximum":2134.0300,"gross_charge":2134.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical; colectomy, total, abdominal with proctectomy with ileostomy","code_information":[ { "code": "44212", "type": "DRG" } ],"standard_charges":[{"minimum":2803.7200,"maximum":2803.7200,"gross_charge":2803.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2803.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical; colectomy, total, abdominal without proctectomy with ileostomy or ileoproctostomy","code_information":[ { "code": "44210", "type": "DRG" } ],"standard_charges":[{"minimum":2455.0300,"maximum":2455.0300,"gross_charge":2455.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2455.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis","code_information":[ { "code": "44202", "type": "DRG" } ],"standard_charges":[{"minimum":1933.4600,"maximum":1933.4600,"gross_charge":1933.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1933.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laparoscopy, surgical; proctopexy","code_information":[ { "code": "45400", "type": "DRG" } ],"standard_charges":[{"minimum":1574.6200,"maximum":1574.6200,"gross_charge":1574.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1574.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Large Clip Applier","code_information":[ { "code": "3021110", "type": "DRG" } ],"standard_charges":[{"minimum":2058.0000,"maximum":2058.0000,"gross_charge":2058.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2058.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Large Needle Driver","code_information":[ { "code": "3021146", "type": "DRG" } ],"standard_charges":[{"minimum":3749.2000,"maximum":3749.2000,"gross_charge":3749.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3749.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Large Pediatric Underbody","code_information":[ { "code": "270000589", "type": "DRG" } ],"standard_charges":[{"minimum":37.1000,"maximum":37.1000,"gross_charge":37.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laringeal Mask 1.5","code_information":[ { "code": "3009197", "type": "DRG" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; for aspiration","code_information":[ { "code": "31515", "type": "DRG" } ],"standard_charges":[{"minimum":152.4000,"maximum":152.4000,"gross_charge":152.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Laser Sheath Kit 12F","code_information":[ { "code": "2800723", "type": "DRG" } ],"standard_charges":[{"minimum":3391.5000,"maximum":3391.5000,"gross_charge":3391.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lead","code_information":[ { "code": "83655", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LEAD 4965-35 US UNI EPI STERD 35CM","code_information":[ { "code": "2700321", "type": "DRG" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LEAD 693558 SPRINT QUATTRO US MRI","code_information":[ { "code": "2790249", "type": "DRG" } ],"standard_charges":[{"minimum":1057.0000,"maximum":1057.0000,"gross_charge":1057.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lead ACC KIT 6056M Global 17L NEW ACI","code_information":[ { "code": "2780323", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LEAD Adapter UNI-Polar 6MM TO IS1 6161","code_information":[ { "code": "2760515", "type": "DRG" } ],"standard_charges":[{"minimum":1050.0000,"maximum":1050.0000,"gross_charge":1050.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lead Cap","code_information":[ { "code": "270000591", "type": "DRG" } ],"standard_charges":[{"minimum":61.6000,"maximum":61.6000,"gross_charge":61.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lead Cutter","code_information":[ { "code": "2790573", "type": "DRG" } ],"standard_charges":[{"minimum":99.7500,"maximum":99.7500,"gross_charge":99.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Left heart catheterization by transeptal punture through intact septum or by transapical punture","code_information":[ { "code": "93462", "type": "DRG" } ],"standard_charges":[{"minimum":282.1800,"maximum":282.1800,"gross_charge":282.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed","code_information":[ { "code": "93452", "type": "DRG" } ],"standard_charges":[{"minimum":1242.0400,"maximum":1242.0400,"gross_charge":1242.0400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1242.0400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Legionella Antibody","code_information":[ { "code": "86713", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Legionella pneumophila DFA","code_information":[ { "code": "87278", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LeMaitre Valvulotome 1.5mm","code_information":[ { "code": "270000621", "type": "DRG" } ],"standard_charges":[{"minimum":2800.0000,"maximum":2800.0000,"gross_charge":2800.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Leukocyte assessment, fecal, Qualitative or semiquantitative","code_information":[ { "code": "89055", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Leukoreduced RBC Imported form US","code_information":[ { "code": "EU101", "type": "DRG" } ],"standard_charges":[{"minimum":250.0000,"maximum":250.0000,"gross_charge":250.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Levetiracetam","code_information":[ { "code": "80177", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lidocaine","code_information":[ { "code": "80176", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Liga Clip Large 11.5","code_information":[ { "code": "270001263", "type": "DRG" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Liga Clip Medium 9.75","code_information":[ { "code": "270001265", "type": "DRG" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Liga Clip Small 9.0","code_information":[ { "code": "270001267", "type": "DRG" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LigaSure Small Jaw Open Sealer\/Divider","code_information":[ { "code": "270000623", "type": "DRG" } ],"standard_charges":[{"minimum":602.0000,"maximum":602.0000,"gross_charge":602.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ligation, division and stripping, short saphenous vein","code_information":[ { "code": "37718", "type": "DRG" } ],"standard_charges":[{"minimum":540.4700,"maximum":540.4700,"gross_charge":540.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":540.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LINQ II LNQ22","code_information":[ { "code": "3018128", "type": "DRG" } ],"standard_charges":[{"minimum":2800.0000,"maximum":2800.0000,"gross_charge":2800.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2800.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipase","code_information":[ { "code": "83690", "type": "DRG" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipid Panel","code_information":[ { "code": "80061", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipoprotein A","code_information":[ { "code": "83695", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipoprotein, direct measurement; high density cholesterol (HDL Cholesterol)","code_information":[ { "code": "83718", "type": "DRG" } ],"standard_charges":[{"minimum":18.2000,"maximum":18.2000,"gross_charge":18.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipoprotein, direct measurement; high density cholesterol (LDL Cholesterol)","code_information":[ { "code": "83721", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lipoprotein-associated Phospholipase","code_information":[ { "code": "83698", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lithium","code_information":[ { "code": "80178", "type": "DRG" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LLD E","code_information":[ { "code": "2790579", "type": "DRG" } ],"standard_charges":[{"minimum":642.8400,"maximum":642.8400,"gross_charge":642.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":642.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lock Pericardiocentesis Set 8.3F\/40cm","code_information":[ { "code": "270000625", "type": "DRG" } ],"standard_charges":[{"minimum":336.0000,"maximum":336.0000,"gross_charge":336.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Long Bipolar Grasper","code_information":[ { "code": "3021144", "type": "DRG" } ],"standard_charges":[{"minimum":5968.2000,"maximum":5968.2000,"gross_charge":5968.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5968.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lower esophageal myotomy, transoral (ei, peroral endoscopic myotomy (POEM))","code_information":[ { "code": "43497", "type": "DRG" } ],"standard_charges":[{"minimum":1095.8100,"maximum":1095.8100,"gross_charge":1095.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1095.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lunderquist .035\"\/300cm","code_information":[ { "code": "270000631", "type": "DRG" } ],"standard_charges":[{"minimum":1358.0000,"maximum":1358.0000,"gross_charge":1358.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1358.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Lunderquist 75mm\/.35\"\/260cm","code_information":[ { "code": "270000633", "type": "DRG" } ],"standard_charges":[{"minimum":233.8000,"maximum":233.8000,"gross_charge":233.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":233.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"LV-1 Lead Cap (Model 6742)","code_information":[ { "code": "270000635", "type": "DRG" } ],"standard_charges":[{"minimum":61.6000,"maximum":61.6000,"gross_charge":61.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Magna Ease Pericardial","code_information":[ { "code": "3007437", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Magna Mitral Ease Pericardial","code_information":[ { "code": "3019714", "type": "DRG" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Magnesium","code_information":[ { "code": "83735", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Male External Catheter (Condon) Large","code_information":[ { "code": "2709390", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Manganese","code_information":[ { "code": "83785", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mastotomy with exploration or drainage of abcess, deep","code_information":[ { "code": "19020", "type": "DRG" } ],"standard_charges":[{"minimum":444.4300,"maximum":444.4300,"gross_charge":444.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":444.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MB fraction only","code_information":[ { "code": "82553", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mediastinoscopy; includes biopsy of mediastinal mass, when performed","code_information":[ { "code": "39401", "type": "DRG" } ],"standard_charges":[{"minimum":424.2400,"maximum":424.2400,"gross_charge":424.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":424.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mediastinotomy with exploration, drainage, removal of foreing body or biopsy; cervical approah","code_information":[ { "code": "39000", "type": "DRG" } ],"standard_charges":[{"minimum":694.9900,"maximum":694.9900,"gross_charge":694.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":706.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":694.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mediastinotomy with exploration, drainage, removal of foreing body or biopsy; transthoracic approach, including either transthoracic or median sternotomy","code_information":[ { "code": "39010", "type": "DRG" } ],"standard_charges":[{"minimum":1075.5600,"maximum":1075.5600,"gross_charge":1075.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1075.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Medium-Large Clip Applier","code_information":[ { "code": "3021111", "type": "DRG" } ],"standard_charges":[{"minimum":1470.0000,"maximum":1470.0000,"gross_charge":1470.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Medtronic 6500 Temporary Myocardial","code_information":[ { "code": "270001273", "type": "DRG" } ],"standard_charges":[{"minimum":31.5000,"maximum":31.5000,"gross_charge":31.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mega Needle Driver","code_information":[ { "code": "3021113", "type": "DRG" } ],"standard_charges":[{"minimum":3234.0000,"maximum":3234.0000,"gross_charge":3234.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3234.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mega SutureCut Needle Driver","code_information":[ { "code": "3021119", "type": "DRG" } ],"standard_charges":[{"minimum":3859.8000,"maximum":3859.8000,"gross_charge":3859.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3859.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Megadyne Electrosurgical Patient","code_information":[ { "code": "270000641", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Megadyne Filter Fluid Trap","code_information":[ { "code": "270000643", "type": "DRG" } ],"standard_charges":[{"minimum":133.0000,"maximum":133.0000,"gross_charge":133.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Megadyne Laparoscopic Tubing","code_information":[ { "code": "270000645", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Melody Transcatheter Pulmonary Valve","code_information":[ { "code": "3020174", "type": "DRG" } ],"standard_charges":[{"minimum":25200.0000,"maximum":25200.0000,"gross_charge":25200.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25200.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Metanephrines","code_information":[ { "code": "83835", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Methadone","code_information":[ { "code": "80358", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Micra VR2 MC2VR01 Single chamber","code_information":[ { "code": "3019124", "type": "DRG" } ],"standard_charges":[{"minimum":12537.0000,"maximum":12537.0000,"gross_charge":12537.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12537.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Micra AV2 Dual chamber transcatheter","code_information":[ { "code": "3020723", "type": "DRG" } ],"standard_charges":[{"minimum":14980.0000,"maximum":14980.0000,"gross_charge":14980.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14980.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Micro-Blade Straight Blade & Threaded","code_information":[ { "code": "270000647", "type": "DRG" } ],"standard_charges":[{"minimum":39.4800,"maximum":39.4800,"gross_charge":39.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MICRONY SR","code_information":[ { "code": "3020148", "type": "DRG" } ],"standard_charges":[{"minimum":3486.0000,"maximum":3486.0000,"gross_charge":3486.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3486.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Micropuncture Introducer Set 21G\/ 7 cm","code_information":[ { "code": "270000651", "type": "DRG" } ],"standard_charges":[{"minimum":34.1600,"maximum":34.1600,"gross_charge":34.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Microsomal antibodies, each","code_information":[ { "code": "86376", "type": "DRG" } ],"standard_charges":[{"minimum":21.6300,"maximum":21.6300,"gross_charge":21.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mitra Clip G4 Clip Delivery System","code_information":[ { "code": "3019163", "type": "DRG" } ],"standard_charges":[{"minimum":30800.0000,"maximum":30800.0000,"gross_charge":30800.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30800.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mitral Stented Porcine, Epic Model:","code_information":[ { "code": "3018151", "type": "DRG" } ],"standard_charges":[{"minimum":4025.0000,"maximum":4025.0000,"gross_charge":4025.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4025.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mitris Resilia Mitral Valve","code_information":[ { "code": "3021078", "type": "DRG" } ],"standard_charges":[{"minimum":7350.0000,"maximum":7350.0000,"gross_charge":7350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mitris Resilia Mitral 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separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mobilization (take-down) of the splenic flexure performed in conjunction with a partial colectomy","code_information":[ { "code": "44139", "type": "DRG" } ],"standard_charges":[{"minimum":165.7600,"maximum":165.7600,"gross_charge":165.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare 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separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Molecular pathology procedure, Level 7, ACADVL, full gene sequence","code_information":[ { "code": "81406", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Momentum CRT-D G124","code_information":[ { "code": "3019295", "type": "DRG" } ],"standard_charges":[{"minimum":9139.2000,"maximum":9139.2000,"gross_charge":9139.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Momentum EL ICD DR 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separately","standard_charge_dollar":9513.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9513.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Momentum EL ICD VR D120","code_information":[ { "code": "3019626", "type": "DRG" } ],"standard_charges":[{"minimum":7795.2000,"maximum":7795.2000,"gross_charge":7795.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Momentum X4 CRT-D G138","code_information":[ { "code": "3019852", "type": "DRG" } ],"standard_charges":[{"minimum":9940.0000,"maximum":9940.0000,"gross_charge":9940.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9940.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mosaic 310 Bioprosthesis Mitral Valve","code_information":[ { "code": "2750280", "type": "DRG" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mosaic Ultra 305 Bioprosthesis Aortic","code_information":[ { "code": "2750279", "type": "DRG" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;","code_information":[ { "code": "75561", "type": "DRG" } ],"standard_charges":[{"minimum":525.0600,"maximum":525.0600,"gross_charge":525.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Cardiac magnetic resonance imaging for velocity flow mapping","code_information":[ { "code": "75565", "type": "DRG" } ],"standard_charges":[{"minimum":65.6000,"maximum":65.6000,"gross_charge":65.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Cholangiography, oral contrast","code_information":[ { "code": "74290", "type": "DRG" } ],"standard_charges":[{"minimum":125.1300,"maximum":125.1300,"gross_charge":125.1300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":125.1300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, porton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)","code_information":[ { "code": "71550", "type": "DRG" } ],"standard_charges":[{"minimum":507.6500,"maximum":507.6500,"gross_charge":507.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.6500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, porton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "71552", "type": "DRG" } ],"standard_charges":[{"minimum":708.6400,"maximum":708.6400,"gross_charge":708.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":708.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)","code_information":[ { "code": "74182", "type": "DRG" } ],"standard_charges":[{"minimum":453.4900,"maximum":453.4900,"gross_charge":453.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":453.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)","code_information":[ { "code": "74181", "type": "DRG" } ],"standard_charges":[{"minimum":292.4700,"maximum":292.4700,"gross_charge":292.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and futher sequences","code_information":[ { "code": "74183", "type": "DRG" } ],"standard_charges":[{"minimum":506.3800,"maximum":506.3800,"gross_charge":506.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)","code_information":[ { "code": "73722", "type": "DRG" } ],"standard_charges":[{"minimum":469.8400,"maximum":469.8400,"gross_charge":469.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material","code_information":[ { "code": "73721", "type": "DRG" } ],"standard_charges":[{"minimum":301.1400,"maximum":301.1400,"gross_charge":301.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "73723", "type": "DRG" } ],"standard_charges":[{"minimum":579.1000,"maximum":579.1000,"gross_charge":579.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, brain (including brian stem); with contrast material(s)","code_information":[ { "code": "70552", "type": "DRG" } ],"standard_charges":[{"minimum":403.7300,"maximum":403.7300,"gross_charge":403.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, brain (including brian stem); without contrast material","code_information":[ { "code": "70551", "type": "DRG" } ],"standard_charges":[{"minimum":291.5100,"maximum":291.5100,"gross_charge":291.5100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.5100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, brain (including brian stem); without contrast material, followed by contrast material(s) and futher sequences","code_information":[ { "code": "70553", "type": "DRG" } ],"standard_charges":[{"minimum":475.2600,"maximum":475.2600,"gross_charge":475.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":475.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)","code_information":[ { "code": "73719", "type": "DRG" } ],"standard_charges":[{"minimum":392.3600,"maximum":392.3600,"gross_charge":392.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)","code_information":[ { "code": "73718", "type": "DRG" } ],"standard_charges":[{"minimum":334.1400,"maximum":334.1400,"gross_charge":334.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":334.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "73720", "type": "DRG" } ],"standard_charges":[{"minimum":504.9700,"maximum":504.9700,"gross_charge":504.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, orbit, face, and\/or neck with and without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "70543", "type": "DRG" } ],"standard_charges":[{"minimum":506.8800,"maximum":506.8800,"gross_charge":506.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":506.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, orbit, face, and\/or neck, with contrast material(s)","code_information":[ { "code": "70542", "type": "DRG" } ],"standard_charges":[{"minimum":401.4500,"maximum":401.4500,"gross_charge":401.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, orbit, face, and\/or neck, without contrast material","code_information":[ { "code": "70540", "type": "DRG" } ],"standard_charges":[{"minimum":337.9600,"maximum":337.9600,"gross_charge":337.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":337.9600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)","code_information":[ { "code": "72196", "type": "DRG" } ],"standard_charges":[{"minimum":401.8700,"maximum":401.8700,"gross_charge":401.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":401.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)","code_information":[ { "code": "72195", "type": "DRG" } ],"standard_charges":[{"minimum":342.2200,"maximum":342.2200,"gross_charge":342.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":342.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "72197", "type": "DRG" } ],"standard_charges":[{"minimum":504.4600,"maximum":504.4600,"gross_charge":504.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material","code_information":[ { "code": "72149", "type": "DRG" } ],"standard_charges":[{"minimum":403.7600,"maximum":403.7600,"gross_charge":403.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material","code_information":[ { "code": "72148", "type": "DRG" } ],"standard_charges":[{"minimum":284.3400,"maximum":284.3400,"gross_charge":284.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":284.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material","code_information":[ { "code": "72146", "type": "DRG" } ],"standard_charges":[{"minimum":283.3900,"maximum":283.3900,"gross_charge":283.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and futher sequences; cervical","code_information":[ { "code": "72156", "type": "DRG" } ],"standard_charges":[{"minimum":477.6400,"maximum":477.6400,"gross_charge":477.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and futher sequences; lumbar","code_information":[ { "code": "72158", "type": "DRG" } ],"standard_charges":[{"minimum":476.6900,"maximum":476.6900,"gross_charge":476.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":476.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and futher sequences; thoracic","code_information":[ { "code": "72157", "type": "DRG" } ],"standard_charges":[{"minimum":478.6000,"maximum":478.6000,"gross_charge":478.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, spinal canal and its contents, cervical; without contrast material","code_information":[ { "code": "72141", "type": "DRG" } ],"standard_charges":[{"minimum":283.3900,"maximum":283.3900,"gross_charge":283.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":283.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)","code_information":[ { "code": "70336", "type": "DRG" } ],"standard_charges":[{"minimum":396.7200,"maximum":396.7200,"gross_charge":396.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)","code_information":[ { "code": "73219", "type": "DRG" } ],"standard_charges":[{"minimum":498.0200,"maximum":498.0200,"gross_charge":498.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)","code_information":[ { "code": "73218", "type": "DRG" } ],"standard_charges":[{"minimum":456.0600,"maximum":456.0600,"gross_charge":456.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":456.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "73220", "type": "DRG" } ],"standard_charges":[{"minimum":615.4400,"maximum":615.4400,"gross_charge":615.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":615.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, abdomen, with or without contrast material(s)","code_information":[ { "code": "74185", "type": "DRG" } ],"standard_charges":[{"minimum":503.6800,"maximum":503.6800,"gross_charge":503.6800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":503.6800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, chest (excluding the myocardium), with or without the use of contrast material(s)","code_information":[ { "code": "71555", "type": "DRG" } ],"standard_charges":[{"minimum":498.4100,"maximum":498.4100,"gross_charge":498.4100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":498.4100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, head; with contrast material(s)","code_information":[ { "code": "70545", "type": "DRG" } ],"standard_charges":[{"minimum":338.9700,"maximum":338.9700,"gross_charge":338.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":338.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, head; without contrast material(s)","code_information":[ { "code": "70544", "type": "DRG" } ],"standard_charges":[{"minimum":320.8100,"maximum":320.8100,"gross_charge":320.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "70546", "type": "DRG" } ],"standard_charges":[{"minimum":491.3900,"maximum":491.3900,"gross_charge":491.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":491.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, lower extremity, with or without contrast material(s)","code_information":[ { "code": "73725", "type": "DRG" } ],"standard_charges":[{"minimum":500.7900,"maximum":500.7900,"gross_charge":500.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, neck; with contrast material(s)","code_information":[ { "code": "70548", "type": "DRG" } ],"standard_charges":[{"minimum":366.5600,"maximum":366.5600,"gross_charge":366.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":366.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, neck; without contrast material(s)","code_information":[ { "code": "70547", "type": "DRG" } ],"standard_charges":[{"minimum":321.2900,"maximum":321.2900,"gross_charge":321.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":321.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and futher sequences","code_information":[ { "code": "70549", "type": "DRG" } ],"standard_charges":[{"minimum":515.1600,"maximum":515.1600,"gross_charge":515.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":515.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, pelvis, with or without contrast material(s)","code_information":[ { "code": "72198", "type": "DRG" } ],"standard_charges":[{"minimum":504.6300,"maximum":504.6300,"gross_charge":504.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance angiography, upper extremity, with or without contrast material(s)","code_information":[ { "code": "73225", "type": "DRG" } ],"standard_charges":[{"minimum":512.3200,"maximum":512.3200,"gross_charge":512.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":512.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance(eg, proton) imaging, any joint of upper extremity; with contrast material(s)","code_information":[ { "code": "73222", "type": "DRG" } ],"standard_charges":[{"minimum":469.8400,"maximum":469.8400,"gross_charge":469.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance(eg, proton) imaging, any joint of upper extremity; without contrast material(s)","code_information":[ { "code": "73221", "type": "DRG" } ],"standard_charges":[{"minimum":301.6200,"maximum":301.6200,"gross_charge":301.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR Magnetic resonance(eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed contrast matyerial(s) and futher sequences","code_information":[ { "code": "73223", "type": "DRG" } ],"standard_charges":[{"minimum":581.0000,"maximum":581.0000,"gross_charge":581.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MR MR Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material","code_information":[ { "code": "72147", "type": "DRG" } ],"standard_charges":[{"minimum":407.5800,"maximum":407.5800,"gross_charge":407.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":407.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MTHFR gene analysis, common variants","code_information":[ { "code": "81291", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mucin Synovial Fluid","code_information":[ { "code": "83872", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Multi Stage Femoral Veus W\/PERC #25","code_information":[ { "code": "2720991", "type": "DRG" } ],"standard_charges":[{"minimum":65.8000,"maximum":65.8000,"gross_charge":65.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mumps Virus IgG Antibody","code_information":[ { "code": "86735", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Muscle, myocutaneous or fasciocutaneous flap; Trunk","code_information":[ { "code": "15734", "type": "DRG" } ],"standard_charges":[{"minimum":2064.6900,"maximum":2064.6900,"gross_charge":2064.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2064.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mycobacteria tuberculosis; direct probe technique","code_information":[ { "code": "87556", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mycoplasma","code_information":[ { "code": "86738", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Mycoplasma Pneumoniae IgG Ab","code_information":[ { "code": "87638", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Myeloperoxidase","code_information":[ { "code": "83876", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MYNX Control Vascular Closure Device","code_information":[ { "code": "3021058", "type": "DRG" } ],"standard_charges":[{"minimum":252.0000,"maximum":252.0000,"gross_charge":252.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Myo\/Wire Temporary Cardiac Pacing Wire","code_information":[ { "code": "270000669", "type": "DRG" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"MYO\/Wire Ultra-Thin Bipolar V - 60cm -","code_information":[ { "code": "270001275", "type": "DRG" } ],"standard_charges":[{"minimum":44.4500,"maximum":44.4500,"gross_charge":44.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Myoglobin","code_information":[ { "code": "83874", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Myowire Temporary Cardiac Pacing Wire","code_information":[ { "code": "270001277", "type": "DRG" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NaCross Elite PTA Balloon","code_information":[ { "code": "270000671", "type": "DRG" } ],"standard_charges":[{"minimum":245.0000,"maximum":245.0000,"gross_charge":245.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Nasal smear for eosinophils","code_information":[ { "code": "89190", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Natriuretic Peptide","code_information":[ { "code": "83880", "type": "DRG" } ],"standard_charges":[{"minimum":120.5300,"maximum":120.5300,"gross_charge":120.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Negative pressure wound therapy dme 50< square centimeters","code_information":[ { "code": "97605", "type": "DRG" } ],"standard_charges":[{"minimum":33.0500,"maximum":33.0500,"gross_charge":33.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Neisseria gonorrhoeae, amplified probe technique","code_information":[ { "code": "87591", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Neonatal Peritoneal Dialysis Catheter","code_information":[ { "code": "270000681", "type": "DRG" } ],"standard_charges":[{"minimum":102.9700,"maximum":102.9700,"gross_charge":102.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Nephrectomy, including partial ureterectom, any open approach including rib resection;","code_information":[ { "code": "50220", "type": "DRG" } ],"standard_charges":[{"minimum":1464.5500,"maximum":1464.5500,"gross_charge":1464.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1464.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Neuroplasty and\/or transposition; ulnar nerve at elbow","code_information":[ { "code": "64718", "type": "DRG" } ],"standard_charges":[{"minimum":845.8200,"maximum":845.8200,"gross_charge":845.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":845.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Neutralization test, viral","code_information":[ { "code": "86382", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Nitric Oxide gas per hour","code_information":[ { "code": "95012", "type": "DRG" } ],"standard_charges":[{"minimum":26.2600,"maximum":26.2600,"gross_charge":26.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM 3 phase study","code_information":[ { "code": "78315", "type": "DRG" } ],"standard_charges":[{"minimum":461.4800,"maximum":461.4800,"gross_charge":461.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":461.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Acute gastrointestinal blood loss imaging","code_information":[ { "code": "78278", "type": "DRG" } ],"standard_charges":[{"minimum":464.3700,"maximum":464.3700,"gross_charge":464.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Brain imaging, less than 4 static views;","code_information":[ { "code": "78600", "type": "DRG" } ],"standard_charges":[{"minimum":243.6600,"maximum":243.6600,"gross_charge":243.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":243.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Brain imaging, less than 4 static views; with vascular flow","code_information":[ { "code": "78601", "type": "DRG" } ],"standard_charges":[{"minimum":290.0100,"maximum":290.0100,"gross_charge":290.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":290.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Brain imaging, minimum 4 static views; with vascular flow","code_information":[ { "code": "78606", "type": "DRG" } ],"standard_charges":[{"minimum":435.8100,"maximum":435.8100,"gross_charge":435.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":435.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercises and\/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","code_information":[ { "code": "78481", "type": "DRG" } ],"standard_charges":[{"minimum":238.1700,"maximum":238.1700,"gross_charge":238.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":238.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging using the first pass technique; multiples studies, at rest or with stress (exercises and\/or pharmacologic), wall motion study plus ejection fraction, with or without quantification","code_information":[ { "code": "78483", "type": "DRG" } ],"standard_charges":[{"minimum":320.7100,"maximum":320.7100,"gross_charge":320.7100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.7100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first-pass technique (List separately in addition to code for primary procedure)","code_information":[ { "code": "78496", "type": "DRG" } ],"standard_charges":[{"minimum":59.5600,"maximum":59.5600,"gross_charge":59.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing","code_information":[ { "code": "78494", "type": "DRG" } ],"standard_charges":[{"minimum":306.0000,"maximum":306.0000,"gross_charge":306.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":306.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging, gated equilibrium; planar, multiples study, wall motion study plus ejection fraction, at rest or stress (exercise and\/or pharmacologic), with or without additional quantification","code_information":[ { "code": "78473", "type": "DRG" } ],"standard_charges":[{"minimum":385.7600,"maximum":385.7600,"gross_charge":385.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and\/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative progressing","code_information":[ { "code": "78472", "type": "DRG" } ],"standard_charges":[{"minimum":304.1600,"maximum":304.1600,"gross_charge":304.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM cardiac blood pool rest or stress","code_information":[ { "code": "78482", "type": "DRG" } ],"standard_charges":[{"minimum":304.1600,"maximum":304.1600,"gross_charge":304.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":304.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Cardiac shunt detection","code_information":[ { "code": "78428", "type": "DRG" } ],"standard_charges":[{"minimum":251.1600,"maximum":251.1600,"gross_charge":251.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Dobutamine hydrochloride, per 250 mg","code_information":[ { "code": "J1250", "type": "DRG" } ],"standard_charges":[{"minimum":8.2600,"maximum":8.2600,"gross_charge":8.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Esophageal motility","code_information":[ { "code": "78258", "type": "DRG" } ],"standard_charges":[{"minimum":287.0400,"maximum":287.0400,"gross_charge":287.0400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":287.0400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Gastric emptying imaging study (eg, solid, liquid, or both);","code_information":[ { "code": "78264", "type": "DRG" } ],"standard_charges":[{"minimum":440.5200,"maximum":440.5200,"gross_charge":440.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Gastric mucosa imaging","code_information":[ { "code": "78261", "type": "DRG" } ],"standard_charges":[{"minimum":268.9100,"maximum":268.9100,"gross_charge":268.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Gastroesophageal reflux study","code_information":[ { "code": "78262", "type": "DRG" } ],"standard_charges":[{"minimum":329.6200,"maximum":329.6200,"gross_charge":329.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Hepatobiliary system imaging, including gallbladder when present","code_information":[ { "code": "78226", "type": "DRG" } ],"standard_charges":[{"minimum":433.3700,"maximum":433.3700,"gross_charge":433.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed","code_information":[ { "code": "78227", "type": "DRG" } ],"standard_charges":[{"minimum":433.3700,"maximum":433.3700,"gross_charge":433.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":433.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":582.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Intestine imaging (eg, ectopic grastic mucosa, Meckel's localization, volvulus)","code_information":[ { "code": "78290", "type": "DRG" } ],"standard_charges":[{"minimum":440.0900,"maximum":440.0900,"gross_charge":440.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":440.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging morphology;","code_information":[ { "code": "78700", "type": "DRG" } ],"standard_charges":[{"minimum":229.7800,"maximum":229.7800,"gross_charge":229.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":229.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging morphology; with vascular flow","code_information":[ { "code": "78701", "type": "DRG" } ],"standard_charges":[{"minimum":301.9800,"maximum":301.9800,"gross_charge":301.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin cinverting enzyme inhibitor and\/or diuretic)","code_information":[ { "code": "78709", "type": "DRG" } ],"standard_charges":[{"minimum":493.8100,"maximum":493.8100,"gross_charge":493.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":493.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention","code_information":[ { "code": "78707", "type": "DRG" } ],"standard_charges":[{"minimum":312.3000,"maximum":312.3000,"gross_charge":312.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":312.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin cinverting enzyme inhibitor and\/or diuretic)","code_information":[ { "code": "78708", "type": "DRG" } ],"standard_charges":[{"minimum":248.1200,"maximum":248.1200,"gross_charge":248.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Kidney imaging tomographic (SPECT)","code_information":[ { "code": "78710", "type": "DRG" } ],"standard_charges":[{"minimum":259.3600,"maximum":259.3600,"gross_charge":259.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Liver and spleen imaging; static only","code_information":[ { "code": "78215", "type": "DRG" } ],"standard_charges":[{"minimum":263.7200,"maximum":263.7200,"gross_charge":263.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":263.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Liver imaging SPECT","code_information":[ { "code": "78205", "type": "DRG" } ],"standard_charges":[{"minimum":308.6200,"maximum":308.6200,"gross_charge":308.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":308.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Liver imaging SPECT; with vascular flow","code_information":[ { "code": "78206", "type": "DRG" } ],"standard_charges":[{"minimum":464.3700,"maximum":464.3700,"gross_charge":464.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":496.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Liver imaging: static only","code_information":[ { "code": "78201", "type": "DRG" } ],"standard_charges":[{"minimum":256.0900,"maximum":256.0900,"gross_charge":256.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":256.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Liver imaging: static only with vascular flow","code_information":[ { "code": "78202", "type": "DRG" } ],"standard_charges":[{"minimum":279.5000,"maximum":279.5000,"gross_charge":279.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":279.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Lymphatics and lymph nodes imaging","code_information":[ { "code": "78195", "type": "DRG" } ],"standard_charges":[{"minimum":455.1400,"maximum":455.1400,"gross_charge":455.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial imaging, infart avid, planar; qualitative or quantitative","code_information":[ { "code": "78466", "type": "DRG" } ],"standard_charges":[{"minimum":248.7900,"maximum":248.7900,"gross_charge":248.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":248.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial imaging, infart avid, planar; qualitative or quantitative tomography (SPECT) with or without quantification","code_information":[ { "code": "78469", "type": "DRG" } ],"standard_charges":[{"minimum":297.4900,"maximum":297.4900,"gross_charge":297.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":297.4900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial imaging, infart avid, planar; qualitative or quantitative with ejection fraction by first pass technique","code_information":[ { "code": "78468", "type": "DRG" } ],"standard_charges":[{"minimum":261.6900,"maximum":261.6900,"gross_charge":261.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":261.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial perfusion imaging, planar (including qualitative or quantitative wall montion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and\/or stress (exercise or pharmacologic) and\/or redistribution and\/or rest reinjection","code_information":[ { "code": "78454", "type": "DRG" } ],"standard_charges":[{"minimum":581.3200,"maximum":581.3200,"gross_charge":581.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":581.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial perfusion imaging, planar (including qualitative or quantitative wall montion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)","code_information":[ { "code": "78453", "type": "DRG" } ],"standard_charges":[{"minimum":389.7600,"maximum":389.7600,"gross_charge":389.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Myocardial perfusion imaging, tomography (SPECT), multiple studies, at rest and\/or stress, and\/or redistribution and\/or rest reinjection","code_information":[ { "code": "78452", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":626.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Non cardiac vascular flow imaging, (ie, angiography, venography)","code_information":[ { "code": "78445", "type": "DRG" } ],"standard_charges":[{"minimum":281.3900,"maximum":281.3900,"gross_charge":281.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":281.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Parathyroid planar imaging (including subtraction, when performed);","code_information":[ { "code": "78070", "type": "DRG" } ],"standard_charges":[{"minimum":391.2600,"maximum":391.2600,"gross_charge":391.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":391.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Parathyroid planar imaging, including subtraction, when performed, with tomographic (SPECT)","code_information":[ { "code": "78071", "type": "DRG" } ],"standard_charges":[{"minimum":467.1200,"maximum":467.1200,"gross_charge":467.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Pulmonary perfusion imaging (eg, particulate)","code_information":[ { "code": "78580", "type": "DRG" } ],"standard_charges":[{"minimum":316.2000,"maximum":316.2000,"gross_charge":316.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":316.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging","code_information":[ { "code": "78582", "type": "DRG" } ],"standard_charges":[{"minimum":442.3300,"maximum":442.3300,"gross_charge":442.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Pulmonary ventilation imaging (eg, aerosol or gas)","code_information":[ { "code": "78579", "type": "DRG" } ],"standard_charges":[{"minimum":252.2400,"maximum":252.2400,"gross_charge":252.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":252.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Quantitative differrential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed","code_information":[ { "code": "78598", "type": "DRG" } ],"standard_charges":[{"minimum":403.2000,"maximum":403.2000,"gross_charge":403.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":403.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radionuclear Localiztion of abscess; limited area","code_information":[ { "code": "78805", "type": "DRG" } ],"standard_charges":[{"minimum":268.9700,"maximum":268.9700,"gross_charge":268.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radionuclear Localiztion of abscess; whole body","code_information":[ { "code": "78806", "type": "DRG" } ],"standard_charges":[{"minimum":268.9700,"maximum":268.9700,"gross_charge":268.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":268.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radiopharmaceutical localization of tumor, inflamatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging","code_information":[ { "code": "78800", "type": "DRG" } ],"standard_charges":[{"minimum":336.8100,"maximum":336.8100,"gross_charge":336.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":336.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radiopharmaceutical localization of tumor, inflamatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging","code_information":[ { "code": "78802", "type": "DRG" } ],"standard_charges":[{"minimum":412.7900,"maximum":412.7900,"gross_charge":412.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":412.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radiopharmaceutical localization of tumor, inflamatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single areas (eg, head, neck, chest, pelvis) or acquisition, single day imaging","code_information":[ { "code": "78803", "type": "DRG" } ],"standard_charges":[{"minimum":507.0500,"maximum":507.0500,"gross_charge":507.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":507.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Radiopharmaceutical localization of tumor; planar, whole body, requiring 2 or mor days imaging","code_information":[ { "code": "78804", "type": "DRG" } ],"standard_charges":[{"minimum":861.7000,"maximum":861.7000,"gross_charge":861.7000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":861.7000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Salivary gland function study","code_information":[ { "code": "78232", "type": "DRG" } ],"standard_charges":[{"minimum":145.6100,"maximum":145.6100,"gross_charge":145.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.6100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Salivary gland imaging;","code_information":[ { "code": "78230", "type": "DRG" } ],"standard_charges":[{"minimum":237.9200,"maximum":237.9200,"gross_charge":237.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":237.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Salivary gland imaging; with serial images","code_information":[ { "code": "78231", "type": "DRG" } ],"standard_charges":[{"minimum":147.9900,"maximum":147.9900,"gross_charge":147.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Testicular imaging with vascular flow","code_information":[ { "code": "78761", "type": "DRG" } ],"standard_charges":[{"minimum":286.0900,"maximum":286.0900,"gross_charge":286.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":286.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Thyroid imagig (including vascular flow, when performed);","code_information":[ { "code": "78013", "type": "DRG" } ],"standard_charges":[{"minimum":255.1600,"maximum":255.1600,"gross_charge":255.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Thyroid uptake, single or mutiple quantitative measurement(s) (including stimulation, suppression, or dicharge, when peformed)","code_information":[ { "code": "78012", "type": "DRG" } ],"standard_charges":[{"minimum":115.6000,"maximum":115.6000,"gross_charge":115.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":115.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Ureteral reflux study (radiopharmaceutical voiding cystogram)","code_information":[ { "code": "78740", "type": "DRG" } ],"standard_charges":[{"minimum":291.4200,"maximum":291.4200,"gross_charge":291.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":291.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Urinary bladder residual study (List separately in addiction to code for primary procedure)","code_information":[ { "code": "78730", "type": "DRG" } ],"standard_charges":[{"minimum":97.4800,"maximum":97.4800,"gross_charge":97.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"NM Whole body","code_information":[ { "code": "78306", "type": "DRG" } ],"standard_charges":[{"minimum":394.1100,"maximum":394.1100,"gross_charge":394.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":394.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and\/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","code_information":[ { "code": "36221", "type": "DRG" } ],"standard_charges":[{"minimum":272.2300,"maximum":272.2300,"gross_charge":272.2300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":272.2300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Not otherwise specified, each organism","code_information":[ { "code": "87449", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oligoclonal Bands","code_information":[ { "code": "83916", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open Ablation","code_information":[ { "code": "96353", "type": "DRG" } ],"standard_charges":[{"minimum":1137.1200,"maximum":1137.1200,"gross_charge":1137.1200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1137.1200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open Heart II (Bundle Part I)","code_information":[ { "code": "2711005", "type": "DRG" } ],"standard_charges":[{"minimum":298.2000,"maximum":298.2000,"gross_charge":298.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open Heart II (Bundle Parte II)","code_information":[ { "code": "2711010", "type": "DRG" } ],"standard_charges":[{"minimum":298.2000,"maximum":298.2000,"gross_charge":298.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":298.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open Heart Pack (Latex Free)","code_information":[ { "code": "3021291", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open treatment of metatarsal fracture, includes internal fixation, when performed","code_information":[ { "code": "28485", "type": "DRG" } ],"standard_charges":[{"minimum":800.7900,"maximum":800.7900,"gross_charge":800.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each","code_information":[ { "code": "26735", "type": "DRG" } ],"standard_charges":[{"minimum":850.9500,"maximum":850.9500,"gross_charge":850.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":850.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Opiates, 1 or more","code_information":[ { "code": "80361", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Organic Acid single, quantitative","code_information":[ { "code": "83921", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Organic Acid; total, quantitative, each specimen","code_information":[ { "code": "83918", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Osmolality Urine","code_information":[ { "code": "83935", "type": "DRG" } ],"standard_charges":[{"minimum":15.4000,"maximum":15.4000,"gross_charge":15.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Osmolality; blood","code_information":[ { "code": "83930", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Osteocalcin","code_information":[ { "code": "83937", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Osteotomy of Spine posterior or posterolateral approach; 1 vertebral segment; cervical","code_information":[ { "code": "22010", "type": "DRG" } ],"standard_charges":[{"minimum":1377.9500,"maximum":1377.9500,"gross_charge":1377.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1377.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Osteotomy of Spine posterior or posterolateral approach; 1 vertebral segment; cervical","code_information":[ { "code": "22210", "type": "DRG" } ],"standard_charges":[{"minimum":2528.3000,"maximum":2528.3000,"gross_charge":1377.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2528.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oxalate","code_information":[ { "code": "83945", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oxcarbazepine","code_information":[ { "code": "80183", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oximetry","code_information":[ { "code": "94760", "type": "DRG" } ],"standard_charges":[{"minimum":3.7400,"maximum":3.7400,"gross_charge":3.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oxycodone","code_information":[ { "code": "80365", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Oxygen Nasal Cannula Standard Tip","code_information":[ { "code": "270000699", "type": "DRG" } ],"standard_charges":[{"minimum":39.7600,"maximum":39.7600,"gross_charge":39.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Parathormone","code_information":[ { "code": "83970", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":124.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagopastrostomy, with ot without pyloro plasty","code_information":[ { "code": "43117", "type": "DRG" } ],"standard_charges":[{"minimum":4412.1000,"maximum":4412.1000,"gross_charge":4412.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4412.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagopastrostomy, with or without pylorolasty","code_information":[ { "code": "43122", "type": "DRG" } ],"standard_charges":[{"minimum":3559.6500,"maximum":3559.6500,"gross_charge":3559.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3559.6500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Particle agglutination; screen, each antibody","code_information":[ { "code": "86403", "type": "DRG" } ],"standard_charges":[{"minimum":245.1400,"maximum":245.1400,"gross_charge":245.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Parvovirus","code_information":[ { "code": "86747", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pathogen(s) test for platelets","code_information":[ { "code": "P9100", "type": "DRG" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pediatric Filter","code_information":[ { "code": "2702458", "type": "DRG" } ],"standard_charges":[{"minimum":128.8000,"maximum":128.8000,"gross_charge":128.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":128.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pediatric Tubing Pack","code_information":[ { "code": "2720069", "type": "DRG" } ],"standard_charges":[{"minimum":161.6900,"maximum":161.6900,"gross_charge":161.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percepta CRT-P MRI SureScan W1TR01","code_information":[ { "code": "3018366", "type": "DRG" } ],"standard_charges":[{"minimum":3080.0000,"maximum":3080.0000,"gross_charge":3080.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3080.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Perciva ICD DR D401","code_information":[ { "code": "3020163", "type": "DRG" } ],"standard_charges":[{"minimum":7280.0000,"maximum":7280.0000,"gross_charge":7280.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7280.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Perciva ICD VR D400","code_information":[ { "code": "3019316", "type": "DRG" } ],"standard_charges":[{"minimum":7795.2000,"maximum":7795.2000,"gross_charge":7795.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7795.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Perclose ProStyle Suture-Mediated","code_information":[ { "code": "270000703", "type": "DRG" } ],"standard_charges":[{"minimum":84.9100,"maximum":84.9100,"gross_charge":84.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures, when performed, including all vascular access, imaging guidance and radiologic supervision and interpretartion","code_information":[ { "code": "36836", "type": "DRG" } ],"standard_charges":[{"minimum":484.5400,"maximum":484.5400,"gross_charge":484.5400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":484.5400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous Endoscopic Gastrostomy","code_information":[ { "code": "270001283", "type": "DRG" } ],"standard_charges":[{"minimum":203.0000,"maximum":203.0000,"gross_charge":203.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous Sheat Introducer Kit 8.5","code_information":[ { "code": "270000705", "type": "DRG" } ],"standard_charges":[{"minimum":85.4000,"maximum":85.4000,"gross_charge":85.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transcatheter closure of congenital interatrial communication","code_information":[ { "code": "93580", "type": "DRG" } ],"standard_charges":[{"minimum":1306.1700,"maximum":1306.1700,"gross_charge":1306.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1306.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mistral valve","code_information":[ { "code": "93590", "type": "DRG" } ],"standard_charges":[{"minimum":1457.8600,"maximum":1457.8600,"gross_charge":1457.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1457.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, cathetter placement, left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation","code_information":[ { "code": "33340", "type": "DRG" } ],"standard_charges":[{"minimum":1063.5700,"maximum":1063.5700,"gross_charge":1063.5700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1063.5700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1046.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transcatheter placement of intracoronary stent; single major coronary artery or branch","code_information":[ { "code": "92928", "type": "DRG" } ],"standard_charges":[{"minimum":787.1800,"maximum":787.1800,"gross_charge":787.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":787.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta","code_information":[ { "code": "33897", "type": "DRG" } ],"standard_charges":[{"minimum":777.5200,"maximum":777.5200,"gross_charge":777.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":777.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transluminal coronary angioplasty; single major coronary artery or branch","code_information":[ { "code": "92920", "type": "DRG" } ],"standard_charges":[{"minimum":707.5000,"maximum":707.5000,"gross_charge":707.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":707.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transluminal coronary atherectomy, with or without balloon angioplasty, initial vesse","code_information":[ { "code": "92995", "type": "DRG" } ],"standard_charges":[{"minimum":2500.0000,"maximum":2500.0000,"gross_charge":2500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Percutaneous transluminal pulmonary artery ballon angioplasty; singel vessel","code_information":[ { "code": "92997", "type": "DRG" } ],"standard_charges":[{"minimum":862.9600,"maximum":862.9600,"gross_charge":862.9600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":862.9600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Perfusion Intra-Aortic Ballon (IABP","code_information":[ { "code": "2704755", "type": "DRG" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pericardiectomy, subtotal or complete; without cardiopulmonary bypass","code_information":[ { "code": "33030", "type": "DRG" } ],"standard_charges":[{"minimum":2698.4200,"maximum":2698.4200,"gross_charge":2698.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2698.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pericardiocentesis Tray","code_information":[ { "code": "2750146", "type": "DRG" } ],"standard_charges":[{"minimum":201.6000,"maximum":201.6000,"gross_charge":201.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":201.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pericardiocentesis, including imaging guidance, when performed","code_information":[ { "code": "33016", "type": "DRG" } ],"standard_charges":[{"minimum":314.6100,"maximum":314.6100,"gross_charge":314.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":314.6100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pericardiotomy for removal of clot of foreing body","code_information":[ { "code": "33020", "type": "DRG" } ],"standard_charges":[{"minimum":1116.5400,"maximum":1116.5400,"gross_charge":1116.5400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1116.5400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Peritoneal Dialisis Pediatric Pcs-31","code_information":[ { "code": "2702381", "type": "DRG" } ],"standard_charges":[{"minimum":105.0000,"maximum":105.0000,"gross_charge":105.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Permanent Cautery Hook","code_information":[ { "code": "3021107", "type": "DRG" } ],"standard_charges":[{"minimum":1764.0000,"maximum":1764.0000,"gross_charge":1764.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Permanent Cautery Spatula","code_information":[ { "code": "3021108", "type": "DRG" } ],"standard_charges":[{"minimum":1764.0000,"maximum":1764.0000,"gross_charge":1764.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1764.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"pH; Body Fluid, not otherwise specifed","code_information":[ { "code": "83986", "type": "DRG" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pharmacologic agent administration, including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration , when performed","code_information":[ { "code": "93463", "type": "DRG" } ],"standard_charges":[{"minimum":133.3800,"maximum":133.3800,"gross_charge":133.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phebarbital Sodium Injection, USP 65","code_information":[ { "code": "250001687", "type": "DRG" } ],"standard_charges":[{"minimum":36.8900,"maximum":36.8900,"gross_charge":36.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phencyclidine; Urine","code_information":[ { "code": "83992", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phenobarbital","code_information":[ { "code": "80184", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phenylalanine, blood","code_information":[ { "code": "84030", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phenytoin; free","code_information":[ { "code": "80186", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phenytoin; total","code_information":[ { "code": "80185", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phlebotomy Bag","code_information":[ { "code": "BSSM-47", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phosphatase, alkaline;","code_information":[ { "code": "84075", "type": "DRG" } ],"standard_charges":[{"minimum":14.0000,"maximum":14.0000,"gross_charge":14.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phosphorus inorganic","code_information":[ { "code": "84100", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Phosphorus urine","code_information":[ { "code": "84105", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Physio Flex Annuloplasty Mitral Ring","code_information":[ { "code": "3020621", "type": "DRG" } ],"standard_charges":[{"minimum":2633.4000,"maximum":2633.4000,"gross_charge":2633.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2633.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Physio II Annuloplasty Mitral Ring 24","code_information":[ { "code": "2702785", "type": "DRG" } ],"standard_charges":[{"minimum":1932.0000,"maximum":1932.0000,"gross_charge":1932.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1932.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Physio Tricuspid Annuloplasty Ring","code_information":[ { "code": "3020246", "type": "DRG" } ],"standard_charges":[{"minimum":2772.0000,"maximum":2772.0000,"gross_charge":2772.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2772.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pinnacle Precision Access System","code_information":[ { "code": "3021210", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pinnacle Precision Access System","code_information":[ { "code": "3021212", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pin-plug kit 6719 Connector Port","code_information":[ { "code": "270001353", "type": "DRG" } ],"standard_charges":[{"minimum":41.5800,"maximum":41.5800,"gross_charge":41.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Plasma (single donor), pathogen reduced, frozen, each unit","code_information":[ { "code": "P9071", "type": "DRG" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Plasma, pooled multiple donor; solvent\/detergent treated, frozen, each unit","code_information":[ { "code": "P9023", "type": "DRG" } ],"standard_charges":[{"minimum":550.0000,"maximum":550.0000,"gross_charge":550.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Plasma, pooled, multiple donor, pathogen reduced, frozen, each unit","code_information":[ { "code": "P9070", "type": "DRG" } ],"standard_charges":[{"minimum":500.0000,"maximum":500.0000,"gross_charge":500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelet aggregation, each agent","code_information":[ { "code": "85576", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelet rich plasma, each unit","code_information":[ { "code": "P9020", "type": "DRG" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelet, pheresis, pathogen reduced each unit","code_information":[ { "code": "P9073", "type": "DRG" } ],"standard_charges":[{"minimum":730.0000,"maximum":730.0000,"gross_charge":730.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":730.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelets, leukocytes reduced, CMV-negative, apheresis\/pheresis, each unit","code_information":[ { "code": "P9055", "type": "DRG" } ],"standard_charges":[{"minimum":550.0000,"maximum":550.0000,"gross_charge":550.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":550.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelets, pheresis, each unit","code_information":[ { "code": "P9034", "type": "DRG" } ],"standard_charges":[{"minimum":500.0000,"maximum":500.0000,"gross_charge":500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelets, pheresis, leukocytes reduced, CMV-negative, irradiated, each unit","code_information":[ { "code": "P9053", "type": "DRG" } ],"standard_charges":[{"minimum":650.0000,"maximum":650.0000,"gross_charge":650.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":650.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelets, pheresis, leukocytes reduced, irradiated, each unit","code_information":[ { "code": "P9037", "type": "DRG" } ],"standard_charges":[{"minimum":630.0000,"maximum":630.0000,"gross_charge":630.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Platelets, pheresis, leykocytes reduced, each unit","code_information":[ { "code": "P9035", "type": "DRG" } ],"standard_charges":[{"minimum":585.0000,"maximum":585.0000,"gross_charge":585.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":585.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Plegisol ML","code_information":[ { "code": "2703280", "type": "DRG" } ],"standard_charges":[{"minimum":120.0000,"maximum":120.0000,"gross_charge":120.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":120.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance","code_information":[ { "code": "32556", "type": "DRG" } ],"standard_charges":[{"minimum":170.5100,"maximum":170.5100,"gross_charge":170.5100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.5100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pleurectomy, parietal","code_information":[ { "code": "32310", "type": "DRG" } ],"standard_charges":[{"minimum":1271.3100,"maximum":1271.3100,"gross_charge":1271.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1271.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PleurX pleural catheter Kit","code_information":[ { "code": "2820685", "type": "DRG" } ],"standard_charges":[{"minimum":1050.0000,"maximum":1050.0000,"gross_charge":1050.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PMP22 gene analysis; duplication\/deletion analysis","code_information":[ { "code": "81324", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pooling of platelets or other blood products","code_information":[ { "code": "86965", "type": "DRG" } ],"standard_charges":[{"minimum":600.0000,"maximum":600.0000,"gross_charge":600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Porphobilinogen, urine; qualitative","code_information":[ { "code": "84106", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Porphyrins, urine; qualitative","code_information":[ { "code": "84119", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Potassium Urine","code_information":[ { "code": "84133", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Potassium; serum, plasma or whole blood","code_information":[ { "code": "84132", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prealbumin","code_information":[ { "code": "84134", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Precedex (Dexmedetomidine HCl","code_information":[ { "code": "250000591", "type": "DRG" } ],"standard_charges":[{"minimum":59.3900,"maximum":59.3900,"gross_charge":59.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000749", "type": "DRG" } ],"standard_charges":[{"minimum":98.0000,"maximum":98.0000,"gross_charge":98.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000751", "type": "DRG" } ],"standard_charges":[{"minimum":98.0000,"maximum":98.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000753", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":78.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000755", "type": "DRG" } ],"standard_charges":[{"minimum":98.0000,"maximum":98.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000757", "type": "DRG" } ],"standard_charges":[{"minimum":78.4000,"maximum":78.4000,"gross_charge":98.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000759", "type": "DRG" } ],"standard_charges":[{"minimum":98.0000,"maximum":98.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000761", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":78.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prelude Snap Splittable Sheath","code_information":[ { "code": "270000763", "type": "DRG" } ],"standard_charges":[{"minimum":98.0000,"maximum":98.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pressure Cath Placement Set 3 Fr","code_information":[ { "code": "2703790", "type": "DRG" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pressure Monitoring Set (Transducer)","code_information":[ { "code": "270000765", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pressure Monitoring Set 2.5Fr\/2.5cm","code_information":[ { "code": "270000767", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pressure Monitoring Set TruWaveTM x 2","code_information":[ { "code": "3020180", "type": "DRG" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of RBCs for use in RBC antibody detection, identification, and\/or compatibility testing; by density gradient separation","code_information":[ { "code": "86972", "type": "DRG" } ],"standard_charges":[{"minimum":142.5000,"maximum":142.5000,"gross_charge":142.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":142.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of Red Blood Cells for use in RBC Antibody detection, identification, and\/or compatibility testing; incubation with chemical agents or drugs, each","code_information":[ { "code": "86970", "type": "DRG" } ],"standard_charges":[{"minimum":60.5000,"maximum":60.5000,"gross_charge":60.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of Red Blood Cells for use in RBC Antibody detection, identification, and\/or compatibility testing; incubation with Enzymes, each","code_information":[ { "code": "86971", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption","code_information":[ { "code": "86978", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":121.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of serum for use in RBC antibody identification; by dilution","code_information":[ { "code": "86976", "type": "DRG" } ],"standard_charges":[{"minimum":36.0000,"maximum":36.0000,"gross_charge":36.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each","code_information":[ { "code": "86975", "type": "DRG" } ],"standard_charges":[{"minimum":207.5000,"maximum":207.5000,"gross_charge":207.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":207.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each","code_information":[ { "code": "86977", "type": "DRG" } ],"standard_charges":[{"minimum":59.0000,"maximum":59.0000,"gross_charge":59.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Primidone","code_information":[ { "code": "80188", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PRO Delivery Catheter System 7.7cm x","code_information":[ { "code": "270000771", "type": "DRG" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Procainamide","code_information":[ { "code": "80190", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S 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separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Procalcitonin","code_information":[ { "code": "84145", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Profile 3D 680R Annuloplasty Mitral","code_information":[ { "code": "2711155", "type": "DRG" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Progesterone","code_information":[ { "code": "84144", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"ProGrasp Forceps","code_information":[ { "code": "3021117", "type": "DRG" } ],"standard_charges":[{"minimum":3969.0000,"maximum":3969.0000,"gross_charge":3969.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prolactin","code_information":[ { "code": "84146", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prolene Mesh 12\"x12\"","code_information":[ { "code": "2790486", "type": "DRG" } ],"standard_charges":[{"minimum":295.4700,"maximum":295.4700,"gross_charge":295.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":295.4700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prolene Polypropylene nabsorbable","code_information":[ { "code": "270000825", "type": "DRG" } ],"standard_charges":[{"minimum":203.0000,"maximum":203.0000,"gross_charge":203.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":203.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PROPATEN VASC GRAFT TW PEDS 3mmX10cm","code_information":[ { "code": "2703378", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Propaten Vascular Graft Removable Ring","code_information":[ { "code": "3018721", "type": "DRG" } ],"standard_charges":[{"minimum":4498.2000,"maximum":4498.2000,"gross_charge":1939.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4498.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prostate Specific Antigen; free","code_information":[ { "code": "84154", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prostate Specific Antigen; total","code_information":[ { "code": "84153", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protein, total, except by refractometry; serum, other source","code_information":[ { "code": "84157", "type": "DRG" } ],"standard_charges":[{"minimum":43.2600,"maximum":43.2600,"gross_charge":43.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protein, total, except by refractometry; serum, plasma or whole blood","code_information":[ { "code": "84155", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protein, total, except by refractometry; serum, urine","code_information":[ { "code": "84156", "type": "DRG" } ],"standard_charges":[{"minimum":24.7500,"maximum":24.7500,"gross_charge":24.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protein; Electrophorestic fractionation and quantitation, other fluids with concentration","code_information":[ { "code": "84166", "type": "DRG" } ],"standard_charges":[{"minimum":24.7500,"maximum":24.7500,"gross_charge":24.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":24.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protein; Electrophorestic fractionation and quantitation, serum","code_information":[ { "code": "84165", "type": "DRG" } ],"standard_charges":[{"minimum":23.0000,"maximum":23.0000,"gross_charge":23.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prothrombin Time","code_information":[ { "code": "85610", "type": "DRG" } ],"standard_charges":[{"minimum":63.4500,"maximum":63.4500,"gross_charge":63.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Prothrombin Time; Substitution, plasma fractions, each","code_information":[ { "code": "85611", "type": "DRG" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Protozoa, not elsewhere specified","code_information":[ { "code": "86753", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Proximate Vascular Linear Stapler","code_information":[ { "code": "270000837", "type": "DRG" } ],"standard_charges":[{"minimum":81.2400,"maximum":81.2400,"gross_charge":81.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PTFE Felpa 4x4","code_information":[ { "code": "270001285", "type": "DRG" } ],"standard_charges":[{"minimum":147.0000,"maximum":147.0000,"gross_charge":147.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PTFE Felpa 6x6","code_information":[ { "code": "270000839", "type": "DRG" } ],"standard_charges":[{"minimum":167.0500,"maximum":167.0500,"gross_charge":167.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pump Stand By Perfusion Service (CPS","code_information":[ { "code": "360001729", "type": "DRG" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Punch biopsy of skin; single lesion","code_information":[ { "code": "11104", "type": "DRG" } ],"standard_charges":[{"minimum":63.7800,"maximum":63.7800,"gross_charge":63.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"PVI (pulmonary vein isolation)","code_information":[ { "code": "93656", "type": "DRG" } ],"standard_charges":[{"minimum":1268.3600,"maximum":1268.3600,"gross_charge":1268.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1268.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Pyruvate","code_information":[ { "code": "84210", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Q Fever Antibody","code_information":[ { "code": "86638", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Quadra Allure MP CRT-P","code_information":[ { "code": "3019023", "type": "DRG" } ],"standard_charges":[{"minimum":2940.0000,"maximum":2940.0000,"gross_charge":2940.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Quadra Assura MP CRT-D (CD3369-40Q)","code_information":[ { "code": "2770686", "type": "DRG" } ],"standard_charges":[{"minimum":9592.8000,"maximum":9592.8000,"gross_charge":9592.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9592.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Quarter Left Heart Lead 86 cm 5.9 F","code_information":[ { "code": "2770078", "type": "DRG" } ],"standard_charges":[{"minimum":462.0000,"maximum":462.0000,"gross_charge":462.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Quickflex Left Heart Lead 75 cm","code_information":[ { "code": "2790577", "type": "DRG" } ],"standard_charges":[{"minimum":1918.0000,"maximum":1918.0000,"gross_charge":1918.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1918.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"QWICK Cable W Shield Reprocessing (CDI","code_information":[ { "code": "2701185", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Radial Jaw 4 Pulmonary Standard","code_information":[ { "code": "270001293", "type": "DRG" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Radical resection of tumor soft tissue of neck or anterior thorax; less than 5 cm","code_information":[ { "code": "21557", "type": "DRG" } ],"standard_charges":[{"minimum":1324.8200,"maximum":1324.8200,"gross_charge":1324.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1324.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Radiological guidance (ie fluoroscopy, ultrasound, or computed tomography), for percutaneuos drainage (eg, abscess, specimencollection), with placement of catheter, radilogical supervision and interpreteation","code_information":[ { "code": "75989", "type": "DRG" } ],"standard_charges":[{"minimum":300.0000,"maximum":300.0000,"gross_charge":300.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":300.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"RBC antigens, other than ABO or RH (D) each","code_information":[ { "code": "85905", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"RBC Imported form US","code_information":[ { "code": "EU100", "type": "DRG" } ],"standard_charges":[{"minimum":230.0000,"maximum":230.0000,"gross_charge":230.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"RCB antigens, other than ABO or Rh, Each","code_information":[ { "code": "86905", "type": "DRG" } ],"standard_charges":[{"minimum":47.5000,"maximum":47.5000,"gross_charge":47.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reconstructive repair of pectus excavatum or carinatum; open","code_information":[ { "code": "21740", "type": "DRG" } ],"standard_charges":[{"minimum":1401.5100,"maximum":1401.5100,"gross_charge":1401.5100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1401.5100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1424.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Red blood cells, each unit","code_information":[ { "code": "P9021", "type": "DRG" } ],"standard_charges":[{"minimum":185.0000,"maximum":185.0000,"gross_charge":185.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":185.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Red blood cells, irradiated, each unit","code_information":[ { "code": "P9038", "type": "DRG" } ],"standard_charges":[{"minimum":215.0000,"maximum":215.0000,"gross_charge":215.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":215.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Red blood cells, leukocytes reduced, CMV-negative, irradiate each unit","code_information":[ { "code": "P9058", "type": "DRG" } ],"standard_charges":[{"minimum":250.0000,"maximum":250.0000,"gross_charge":250.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":250.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Red blood cells, leukocytes, reduced, each unit","code_information":[ { "code": "P9016", "type": "DRG" } ],"standard_charges":[{"minimum":198.0000,"maximum":198.0000,"gross_charge":198.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":198.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Red blood cells, washed, each unit","code_information":[ { "code": "P9022", "type": "DRG" } ],"standard_charges":[{"minimum":220.0000,"maximum":220.0000,"gross_charge":220.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Relay Pro Thoracic Stent-Graft System","code_information":[ { "code": "8017785", "type": "DRG" } ],"standard_charges":[{"minimum":14000.0000,"maximum":14000.0000,"gross_charge":14000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reliance 4-Front 0672 59CM","code_information":[ { "code": "3019871", "type": "DRG" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reliance 4-Front 0673 64CM","code_information":[ { "code": "3019339", "type": "DRG" } ],"standard_charges":[{"minimum":1478.4000,"maximum":1478.4000,"gross_charge":1478.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reliant Stent Graft Balloon Catheter","code_information":[ { "code": "2740174", "type": "DRG" } ],"standard_charges":[{"minimum":420.0000,"maximum":420.0000,"gross_charge":420.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reload Linear Stapler 60mm Blue","code_information":[ { "code": "270000851", "type": "DRG" } ],"standard_charges":[{"minimum":53.2000,"maximum":53.2000,"gross_charge":53.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Relocation of skin pocket for pacemaker","code_information":[ { "code": "33222", "type": "DRG" } ],"standard_charges":[{"minimum":474.8500,"maximum":474.8500,"gross_charge":474.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":474.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":467.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of a tunneled central venous access device, with subcutaneous port or pump, central or peripheral insection","code_information":[ { "code": "36590", "type": "DRG" } ],"standard_charges":[{"minimum":262.0900,"maximum":262.0900,"gross_charge":262.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":262.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of Foreing Body in muscle or tendon shealth; simple","code_information":[ { "code": "20520", "type": "DRG" } ],"standard_charges":[{"minimum":208.8100,"maximum":208.8100,"gross_charge":208.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":208.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of implant; superficial","code_information":[ { "code": "20670", "type": "DRG" } ],"standard_charges":[{"minimum":204.6500,"maximum":204.6500,"gross_charge":204.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.6500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of implantable defibrillator pulse generator only","code_information":[ { "code": "33241", "type": "DRG" } ],"standard_charges":[{"minimum":292.2800,"maximum":292.2800,"gross_charge":292.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":292.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system","code_information":[ { "code": "33263", "type": "DRG" } ],"standard_charges":[{"minimum":523.6300,"maximum":523.6300,"gross_charge":523.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":523.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of intra-aortic balloon assist device, percutaneous","code_information":[ { "code": "33968", "type": "DRG" } ],"standard_charges":[{"minimum":46.0900,"maximum":46.0900,"gross_charge":46.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of Lung, other than pneumonectomy; sinlge lobe","code_information":[ { "code": "32480", "type": "DRG" } ],"standard_charges":[{"minimum":2003.6900,"maximum":2003.6900,"gross_charge":2003.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2003.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of lung, pneumonectomy","code_information":[ { "code": "32440", "type": "DRG" } ],"standard_charges":[{"minimum":2160.7900,"maximum":2160.7900,"gross_charge":2160.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2160.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2125.5200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of Lung, Pneumonectomy; extrapleural","code_information":[ { "code": "32445", "type": "DRG" } ],"standard_charges":[{"minimum":4763.2500,"maximum":4763.2500,"gross_charge":4763.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4763.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of permanent pacemaker pulse generator only","code_information":[ { "code": "33233", "type": "DRG" } ],"standard_charges":[{"minimum":322.8800,"maximum":322.8800,"gross_charge":322.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":317.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of permanent pacemaker pulse generator; multiple lead system","code_information":[ { "code": "33229", "type": "DRG" } ],"standard_charges":[{"minimum":513.2500,"maximum":513.2500,"gross_charge":513.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":513.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction","code_information":[ { "code": "33244", "type": "DRG" } ],"standard_charges":[{"minimum":1185.7000,"maximum":1185.7000,"gross_charge":1185.7000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1185.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1166.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal of subcutaneous implantable defibrillator electrode","code_information":[ { "code": "33272", "type": "DRG" } ],"standard_charges":[{"minimum":478.2800,"maximum":478.2800,"gross_charge":478.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":478.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Removal, subcutaneous cardiac rhythm monitor","code_information":[ { "code": "33286", "type": "DRG" } ],"standard_charges":[{"minimum":800.0000,"maximum":800.0000,"gross_charge":800.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":800.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Renal Function Panel","code_information":[ { "code": "80069", "type": "DRG" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Renin","code_information":[ { "code": "84244", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch","code_information":[ { "code": "33641", "type": "DRG" } ],"standard_charges":[{"minimum":2248.4700,"maximum":2248.4700,"gross_charge":2248.4700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2248.4700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2211.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair blood vessel; lower extremity","code_information":[ { "code": "35226", "type": "DRG" } ],"standard_charges":[{"minimum":1133.3800,"maximum":1133.3800,"gross_charge":1133.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1133.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of a thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass","code_information":[ { "code": "33877", "type": "DRG" } ],"standard_charges":[{"minimum":4834.7600,"maximum":4834.7600,"gross_charge":4834.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4834.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of an abdominal aortic\/iliac artery aneurysm (with or without rupture) with an endovascular prosthesis","code_information":[ { "code": "34705", "type": "DRG" } ],"standard_charges":[{"minimum":2075.0200,"maximum":2075.0200,"gross_charge":2075.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2075.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of anomalous coronary artery form pulmonary artery origing; by translocation form pulmonary artery to aorta","code_information":[ { "code": "33506", "type": "DRG" } ],"standard_charges":[{"minimum":2808.8800,"maximum":2808.8800,"gross_charge":2808.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2808.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2763.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of anterior abdominal hernia(s), any approach, initial, including implantation of mash or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible","code_information":[ { "code": "49591", "type": "DRG" } ],"standard_charges":[{"minimum":477.3400,"maximum":477.3400,"gross_charge":477.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of complete artioventricular canal, with or without prosthetic valve","code_information":[ { "code": "33670", "type": "DRG" } ],"standard_charges":[{"minimum":2695.5900,"maximum":2695.5900,"gross_charge":2695.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2695.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of complex cardiac anomalies by closure of atrial septal defect and anastomosis of atria or vena cava to pulmonary artery","code_information":[ { "code": "33615", "type": "DRG" } ],"standard_charges":[{"minimum":2697.7600,"maximum":2697.7600,"gross_charge":2697.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2697.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of complex cardiac anomalies by modified Fontan procedure","code_information":[ { "code": "33617", "type": "DRG" } ],"standard_charges":[{"minimum":2921.0900,"maximum":2921.0900,"gross_charge":2921.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2921.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass","code_information":[ { "code": "33500", "type": "DRG" } ],"standard_charges":[{"minimum":2134.0900,"maximum":2134.0900,"gross_charge":2134.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2134.0900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of Diaphragmatic Hernia, traumatic; acute","code_information":[ { "code": "39540", "type": "DRG" } ],"standard_charges":[{"minimum":1208.9100,"maximum":1208.9100,"gross_charge":1208.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1208.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of Diaphragmatic Hernia, traumatic; chronic","code_information":[ { "code": "39541", "type": "DRG" } ],"standard_charges":[{"minimum":1277.5300,"maximum":1277.5300,"gross_charge":1277.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1277.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of isolated partial anomalous pulmonary venous return","code_information":[ { "code": "33724", "type": "DRG" } ],"standard_charges":[{"minimum":2109.3900,"maximum":2109.3900,"gross_charge":2109.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2109.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of left ventricular outflow tract obstruction by patch enlargment of the outflow tract","code_information":[ { "code": "33414", "type": "DRG" } ],"standard_charges":[{"minimum":2894.1400,"maximum":2894.1400,"gross_charge":2894.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2894.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of patent Ductus Arteriosus; by division, 18 years and older","code_information":[ { "code": "33824", "type": "DRG" } ],"standard_charges":[{"minimum":1604.8800,"maximum":1604.8800,"gross_charge":1604.8800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1604.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of patent Ductus Arteriosus; by ligation","code_information":[ { "code": "33820", "type": "DRG" } ],"standard_charges":[{"minimum":1312.9500,"maximum":1312.9500,"gross_charge":1312.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1312.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of pulmonary artery stenosis by reconstruction with patch or graft","code_information":[ { "code": "33917", "type": "DRG" } ],"standard_charges":[{"minimum":1978.0300,"maximum":1978.0300,"gross_charge":1978.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1978.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of ruptured spleen with or without partial splenectomy","code_information":[ { "code": "38115", "type": "DRG" } ],"standard_charges":[{"minimum":1801.9700,"maximum":1801.9700,"gross_charge":1801.9700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1801.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia","code_information":[ { "code": "33619", "type": "DRG" } ],"standard_charges":[{"minimum":3710.6200,"maximum":3710.6200,"gross_charge":3710.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3710.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair of transposition of the great arteries, aotic pulmonary artery recontruction (eg, JateneType);","code_information":[ { "code": "33778", "type": "DRG" } ],"standard_charges":[{"minimum":3170.4300,"maximum":3170.4300,"gross_charge":3170.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3170.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair transposition of the great arteries with ventricular septal defect and subpulmonary stenosis; without surgical enlargement of ventricular septal defect","code_information":[ { "code": "33770", "type": "DRG" } ],"standard_charges":[{"minimum":2847.2500,"maximum":2847.2500,"gross_charge":2847.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2847.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair, paraesophageal hiatal hernia, including fundoplication, via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis","code_information":[ { "code": "43336", "type": "DRG" } ],"standard_charges":[{"minimum":1962.0300,"maximum":1962.0300,"gross_charge":1962.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1962.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair, paraesophageal hiatal hernia, including fundoplication, via thoracotomy, except neonatal; with implantation of mesh or other prosthesis","code_information":[ { "code": "43335", "type": "DRG" } ],"standard_charges":[{"minimum":1806.1500,"maximum":1806.1500,"gross_charge":1806.1500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1806.1500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair, paraesophageal hiatal hernia, via laparotomy, except neonatal; with implantation of mesh or other prosthesis","code_information":[ { "code": "43333", "type": "DRG" } ],"standard_charges":[{"minimum":1725.0200,"maximum":1725.0200,"gross_charge":1725.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1725.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair, paraesophageal hiatal hernia, via thoracotomy, except neonatal; without implantation of mesh or other prosthesis","code_information":[ { "code": "43334", "type": "DRG" } ],"standard_charges":[{"minimum":1681.8200,"maximum":1681.8200,"gross_charge":1681.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1681.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repair, primary, open or percutaneous, rupture Achilles Tendon","code_information":[ { "code": "27650", "type": "DRG" } ],"standard_charges":[{"minimum":915.8900,"maximum":915.8900,"gross_charge":915.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":915.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement of a gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract","code_information":[ { "code": "43762", "type": "DRG" } ],"standard_charges":[{"minimum":51.6900,"maximum":51.6900,"gross_charge":51.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve","code_information":[ { "code": "33405", "type": "DRG" } ],"standard_charges":[{"minimum":3057.1900,"maximum":3057.1900,"gross_charge":3057.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3057.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross Procedure)","code_information":[ { "code": "33413", "type": "DRG" } ],"standard_charges":[{"minimum":4315.2600,"maximum":4315.2600,"gross_charge":4315.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4315.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, aortic valve; with transventriuclar aortic annulus enlargment","code_information":[ { "code": "33412", "type": "DRG" } ],"standard_charges":[{"minimum":4209.6000,"maximum":4209.6000,"gross_charge":4209.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4209.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, catheter only, of central venous access device, with a subcutaneous port or pump, central or peripheral insertion site","code_information":[ { "code": "36578", "type": "DRG" } ],"standard_charges":[{"minimum":277.0200,"maximum":277.0200,"gross_charge":277.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":277.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, mitral valve, with cardiopulmonary bypass","code_information":[ { "code": "33430", "type": "DRG" } ],"standard_charges":[{"minimum":3834.6800,"maximum":3834.6800,"gross_charge":3834.6800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3834.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3772.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, pulmonary valve","code_information":[ { "code": "33475", "type": "DRG" } ],"standard_charges":[{"minimum":3175.7000,"maximum":3175.7000,"gross_charge":3175.7000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3175.7000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Replacement, tricuspid valve, with cardiopulmonary bypass","code_information":[ { "code": "33465", "type": "DRG" } ],"standard_charges":[{"minimum":3703.9800,"maximum":3703.9800,"gross_charge":3703.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3703.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repositioning of previously implanted cardiac venous system electrode","code_information":[ { "code": "33226", "type": "DRG" } ],"standard_charges":[{"minimum":668.2600,"maximum":668.2600,"gross_charge":668.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":668.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Repositioning of previously implanted transvenous pacemaker or implantable defibrillator electrode","code_information":[ { "code": "33215", "type": "DRG" } ],"standard_charges":[{"minimum":427.4200,"maximum":427.4200,"gross_charge":427.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":427.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resection and repair portion of bronchus when performed at time of lobectomy or segmentectomy","code_information":[ { "code": "32501", "type": "DRG" } ],"standard_charges":[{"minimum":326.7600,"maximum":326.7600,"gross_charge":326.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":326.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resection of apical lung tumor incluiding chest wall resection, rib resection neurovascular dissection, when performed; without chest wall reconstruction","code_information":[ { "code": "32503", "type": "DRG" } ],"standard_charges":[{"minimum":2467.7400,"maximum":2467.7400,"gross_charge":2467.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2467.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resection of mediastinal cyst","code_information":[ { "code": "39200", "type": "DRG" } ],"standard_charges":[{"minimum":1181.8900,"maximum":1181.8900,"gross_charge":1181.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1181.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resection of mediastinal tumor","code_information":[ { "code": "39220", "type": "DRG" } ],"standard_charges":[{"minimum":1570.3800,"maximum":1570.3800,"gross_charge":1570.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1570.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resection or incision of subvalvular tissue for disscrete subvalvular aortic stenosis","code_information":[ { "code": "33415", "type": "DRG" } ],"standard_charges":[{"minimum":2730.1400,"maximum":2730.1400,"gross_charge":2730.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2730.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2775.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Reservoir F\/Autotransfusion Suction","code_information":[ { "code": "2740037", "type": "DRG" } ],"standard_charges":[{"minimum":392.0000,"maximum":392.0000,"gross_charge":392.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resolution Clip","code_information":[ { "code": "2810881", "type": "DRG" } ],"standard_charges":[{"minimum":224.0000,"maximum":224.0000,"gross_charge":224.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resonate EL ICD DR D433","code_information":[ { "code": "3020171", "type": "DRG" } ],"standard_charges":[{"minimum":9100.0000,"maximum":9100.0000,"gross_charge":9100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Resonate X4 CRT-D G447","code_information":[ { "code": "3019548", "type": "DRG" } ],"standard_charges":[{"minimum":9139.2000,"maximum":9139.2000,"gross_charge":9139.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Respiratory Syncytial Virus","code_information":[ { "code": "87420", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Respiratory Syncytial Virus","code_information":[ { "code": "87807", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Respiratory viral, includes multiplex resever transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 tagets","code_information":[ { "code": "87631", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed","code_information":[ { "code": "37193", "type": "DRG" } ],"standard_charges":[{"minimum":462.2900,"maximum":462.2900,"gross_charge":462.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial or peroneal artery, unilateral initial vessel with; artherectomy, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37229", "type": "DRG" } ],"standard_charges":[{"minimum":922.5600,"maximum":922.5600,"gross_charge":922.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":922.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial or peroneal artery, unilateral initial vessel with; transluminal angioplasty","code_information":[ { "code": "37228", "type": "DRG" } ],"standard_charges":[{"minimum":731.9100,"maximum":731.9100,"gross_charge":731.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":731.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial or peroneal artery, unilateral initial vessel; with transluminal stent placement and artherectomy, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37231", "type": "DRG" } ],"standard_charges":[{"minimum":977.7700,"maximum":977.7700,"gross_charge":977.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":977.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial or peroneal artery, unilateral initial vessel; with transluminal stent placement, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37230", "type": "DRG" } ],"standard_charges":[{"minimum":938.2100,"maximum":938.2100,"gross_charge":938.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":938.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial or peroneal artery, unilateral initial vessel; with transluminal stent placement, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37234", "type": "DRG" } ],"standard_charges":[{"minimum":380.7000,"maximum":380.7000,"gross_charge":938.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":380.7000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery, unilateral; with artherectomy, includes angiolasty within the same vessel, when performed","code_information":[ { "code": "37225", "type": "DRG" } ],"standard_charges":[{"minimum":797.0100,"maximum":797.0100,"gross_charge":797.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":797.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery, unilateral; with transluminal angioplasty","code_information":[ { "code": "37224", "type": "DRG" } ],"standard_charges":[{"minimum":602.0800,"maximum":602.0800,"gross_charge":602.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":592.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery, unilateral; with transluminal stent placement, and artherectomy, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37227", "type": "DRG" } ],"standard_charges":[{"minimum":953.4800,"maximum":953.4800,"gross_charge":953.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":953.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery, unilateral; with transluminal stent placement, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37226", "type": "DRG" } ],"standard_charges":[{"minimum":702.1000,"maximum":702.1000,"gross_charge":702.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":702.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open, or percutaneous iliac artery, unilateral initial vessel; with transluminal angioplasty","code_information":[ { "code": "37220", "type": "DRG" } ],"standard_charges":[{"minimum":532.8100,"maximum":532.8100,"gross_charge":532.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":541.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revascularization, endovascular, open, or percutaneous iliac artery, unilateral initial vessel; with transluminal stent placement, includes angioplasty within the same vessel, when performed","code_information":[ { "code": "37221", "type": "DRG" } ],"standard_charges":[{"minimum":667.2000,"maximum":667.2000,"gross_charge":667.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":667.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revision of colostomy; simple","code_information":[ { "code": "44340", "type": "DRG" } ],"standard_charges":[{"minimum":1443.4400,"maximum":1443.4400,"gross_charge":1443.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1443.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":871.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)","code_information":[ { "code": "36832", "type": "DRG" } ],"standard_charges":[{"minimum":1034.9400,"maximum":1034.9400,"gross_charge":1034.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1034.9400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"RH Phenotyping Complete","code_information":[ { "code": "86906", "type": "DRG" } ],"standard_charges":[{"minimum":50.0000,"maximum":50.0000,"gross_charge":50.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rheumatoid Factor; qualitative","code_information":[ { "code": "86430", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rickettsia","code_information":[ { "code": "86757", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Right Heart Catheterization incluiding measurements of oxygen saturation and cardiac output, when performed","code_information":[ { "code": "93451", "type": "DRG" } ],"standard_charges":[{"minimum":1175.8300,"maximum":1175.8300,"gross_charge":1175.8300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1175.8300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Robotic Assisted Surgery","code_information":[ { "code": "360001297", "type": "DRG" } ],"standard_charges":[{"minimum":1500.0000,"maximum":1500.0000,"gross_charge":1500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Robotic Pack","code_information":[ { "code": "3021325", "type": "DRG" } ],"standard_charges":[{"minimum":105.0000,"maximum":105.0000,"gross_charge":105.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rotation Tool Kit 6056","code_information":[ { "code": "270000045", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rotavirus","code_information":[ { "code": "87425", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care","code_information":[ { "code": "59510", "type": "DRG" } ],"standard_charges":[{"minimum":3781.2600,"maximum":3781.2600,"gross_charge":3781.2600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3781.2600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rubella Antibody","code_information":[ { "code": "86762", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Rubeola","code_information":[ { "code": "86765", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Russells viper venom time; diluted","code_information":[ { "code": "85613", "type": "DRG" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safari 2 Guidewire Extra Small","code_information":[ { "code": "3021232", "type": "DRG" } ],"standard_charges":[{"minimum":434.0000,"maximum":434.0000,"gross_charge":434.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":434.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 10F 23 cm (Model","code_information":[ { "code": "270000855", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 6 F \/ 13 cm","code_information":[ { "code": "270000857", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 7F 13 cm (Model)","code_information":[ { "code": "270000047", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 8F 13cm (Model)","code_information":[ { "code": "270000049", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 8F 23cm","code_information":[ { "code": "270000051", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 9F 13 cm (Model)","code_information":[ { "code": "270000053", "type": "DRG" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Safe Sheath II 9F 23 cm (Model","code_information":[ { "code": "270000859", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Salicylate","code_information":[ { "code": "80179", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sapien 3 Ultra RESILIA Transcatheter","code_information":[ { "code": "270001381", "type": "DRG" } ],"standard_charges":[{"minimum":37100.0000,"maximum":37100.0000,"gross_charge":37100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sapien 3 Ultra RESILIA Transcatheter","code_information":[ { "code": "270001383", "type": "DRG" } ],"standard_charges":[{"minimum":37100.0000,"maximum":37100.0000,"gross_charge":37100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sapien 3 Ultra RESILIA Transcatheter","code_information":[ { "code": "270001385", "type": "DRG" } ],"standard_charges":[{"minimum":37100.0000,"maximum":37100.0000,"gross_charge":37100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sapien 3 Ultra RESILIA Transcatheter","code_information":[ { "code": "270001387", "type": "DRG" } ],"standard_charges":[{"minimum":37100.0000,"maximum":37100.0000,"gross_charge":37100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sauvage Filamentous Knitted Polter","code_information":[ { "code": "2770960", "type": "DRG" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Saw Cable","code_information":[ { "code": "2705403", "type": "DRG" } ],"standard_charges":[{"minimum":525.0000,"maximum":525.0000,"gross_charge":525.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":525.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve","code_information":[ { "code": "92133", "type": "DRG" } ],"standard_charges":[{"minimum":51.0000,"maximum":51.0000,"gross_charge":51.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Secondary closure of surgical wound or dehiscence, extensive or complicated","code_information":[ { "code": "13160", "type": "DRG" } ],"standard_charges":[{"minimum":1096.5900,"maximum":1096.5900,"gross_charge":1096.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1096.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Secondary Medication Set","code_information":[ { "code": "270000863", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sedimentation Rate, Erythrocyte; non automated","code_information":[ { "code": "85651", "type": "DRG" } ],"standard_charges":[{"minimum":15.0000,"maximum":15.0000,"gross_charge":15.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, (first order) main renal artery and any accesory renal artery's for renal angiography including arterial puncture and catheter placements, fluroscopy, contrast injections, image postprocessing, permanent recording of images, and radiololgical supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral","code_information":[ { "code": "36251", "type": "DRG" } ],"standard_charges":[{"minimum":341.6800,"maximum":341.6800,"gross_charge":341.6800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":341.6800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":347.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, (first order) main renal artery and any accesory renal artery's for renal angiography including arterial puncture and catheter placements, fluroscopy, contrast injections, image postprocessing, permanent recording of images, and radiololgical supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral","code_information":[ { "code": "36252", "type": "DRG" } ],"standard_charges":[{"minimum":477.6100,"maximum":477.6100,"gross_charge":477.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":477.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":485.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity arterial branch, within a vascular family","code_information":[ { "code": "36245", "type": "DRG" } ],"standard_charges":[{"minimum":320.3900,"maximum":320.3900,"gross_charge":320.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":320.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, arterial systems, initial second order thoracic or brachiocephalic branch, within a vascular family","code_information":[ { "code": "36216", "type": "DRG" } ],"standard_charges":[{"minimum":371.0300,"maximum":371.0300,"gross_charge":371.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, arterial systems; each fisrt order thoracic or branchiocephalic branch, within a vascular family","code_information":[ { "code": "36215", "type": "DRG" } ],"standard_charges":[{"minimum":289.3700,"maximum":289.3700,"gross_charge":289.3700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":289.3700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","code_information":[ { "code": "36222", "type": "DRG" } ],"standard_charges":[{"minimum":385.5000,"maximum":385.5000,"gross_charge":385.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":385.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cerviocerebral arch, when performed","code_information":[ { "code": "36223", "type": "DRG" } ],"standard_charges":[{"minimum":452.8300,"maximum":452.8300,"gross_charge":452.8300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.8300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, external carothid artery, unilateral, with angiography of the ipsiliateral external carotid circulation and all associated radiological supervision and interpretation","code_information":[ { "code": "36227", "type": "DRG" } ],"standard_charges":[{"minimum":163.8700,"maximum":163.8700,"gross_charge":163.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cerviocerebral arch, when performed","code_information":[ { "code": "36224", "type": "DRG" } ],"standard_charges":[{"minimum":500.3600,"maximum":500.3600,"gross_charge":500.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed","code_information":[ { "code": "36225", "type": "DRG" } ],"standard_charges":[{"minimum":449.0900,"maximum":449.0900,"gross_charge":449.0900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":449.0900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsiliateral vertebral circulation and all associated radiological supervision and interpretation.; includes angiography of the cervicocerebral arch, when performed","code_information":[ { "code": "36226", "type": "DRG" } ],"standard_charges":[{"minimum":497.1700,"maximum":497.1700,"gross_charge":497.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":497.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SelectSure MRI Sure Scan 3830-69cm","code_information":[ { "code": "2790603", "type": "DRG" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Selenium","code_information":[ { "code": "84255", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270000055", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270000057", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270000059", "type": "DRG" } ],"standard_charges":[{"minimum":420.0000,"maximum":420.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":420.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270000061", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270000063", "type": "DRG" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sentrant Introducer Sheath with","code_information":[ { "code": "270001295", "type": "DRG" } ],"standard_charges":[{"minimum":634.2000,"maximum":634.2000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft","code_information":[ { "code": "30520", "type": "DRG" } ],"standard_charges":[{"minimum":939.6700,"maximum":939.6700,"gross_charge":939.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":939.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Set Cardioplegia","code_information":[ { "code": "2703045", "type": "DRG" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Severe acute respiratory syndrome coronavirus 2","code_information":[ { "code": "86769", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) amplified probe technique","code_information":[ { "code": "87635", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sex Hormone Binding Globulin","code_information":[ { "code": "84270", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiga like toxin","code_information":[ { "code": "87427", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Adult Flexible Tracheostomy","code_information":[ { "code": "270000871", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Endobronchial Tube Kit Left 28","code_information":[ { "code": "270000873", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Endobronchial Tube Kit Left 35","code_information":[ { "code": "270000875", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Endobronchial Tube Kit Left 37","code_information":[ { "code": "270000877", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Endobronchial Tube Kit Left 39","code_information":[ { "code": "270000879", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Pediatric Tracheostomy Cuffless","code_information":[ { "code": "270000881", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shiley Pediatric Tracheostomy Cuffless","code_information":[ { "code": "270000883", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shunt; ascending aorta to pulmonary artery (Waterston type operation)","code_information":[ { "code": "33755", "type": "DRG" } ],"standard_charges":[{"minimum":1789.9100,"maximum":1789.9100,"gross_charge":1789.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1789.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shunt; subclavian to pulmunary artery (Blalock-Taussing type operation)","code_information":[ { "code": "33750", "type": "DRG" } ],"standard_charges":[{"minimum":1708.4500,"maximum":1708.4500,"gross_charge":1708.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1708.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shunt; superior vena cava to pulmonary artery for flow to 1 lung (classical Glenn procedure)","code_information":[ { "code": "33766", "type": "DRG" } ],"standard_charges":[{"minimum":1802.2800,"maximum":1802.2800,"gross_charge":1802.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1802.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Shunt; superior vena cava to pulmonary artery for flow to both lung (bidirectional Glenn procedure)","code_information":[ { "code": "33767", "type": "DRG" } ],"standard_charges":[{"minimum":1923.1000,"maximum":1923.1000,"gross_charge":1923.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1923.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1955.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sickling of RCB, reduction","code_information":[ { "code": "85660", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sigmoidoscopy, flexible; diagnostic, including collection of speciment(s) by brushing or washing, when performed","code_information":[ { "code": "45330", "type": "DRG" } ],"standard_charges":[{"minimum":78.8900,"maximum":78.8900,"gross_charge":78.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Single Use Aspiration Needle","code_information":[ { "code": "3021341", "type": "DRG" } ],"standard_charges":[{"minimum":1419.6000,"maximum":1419.6000,"gross_charge":1419.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1419.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Single Use Suction Valve Model MAJ-209","code_information":[ { "code": "3008850", "type": "DRG" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sirolimus","code_information":[ { "code": "80195", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Six Shooter Saeed Multi-Band Ligator","code_information":[ { "code": "270001297", "type": "DRG" } ],"standard_charges":[{"minimum":558.6000,"maximum":558.6000,"gross_charge":558.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":558.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SJM Masters HP Series Valved Graft","code_information":[ { "code": "2703870", "type": "DRG" } ],"standard_charges":[{"minimum":7600.0000,"maximum":7600.0000,"gross_charge":7600.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7600.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SJM Masters Series Mechanical Heart","code_information":[ { "code": "2720093", "type": "DRG" } ],"standard_charges":[{"minimum":5726.0000,"maximum":5726.0000,"gross_charge":5726.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SJM Pericardial Patch With EnCap","code_information":[ { "code": "3018375", "type": "DRG" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Small Bond Blade Micro Sagittal 16.1","code_information":[ { "code": "270000887", "type": "DRG" } ],"standard_charges":[{"minimum":82.6000,"maximum":82.6000,"gross_charge":82.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Small Clip Applier","code_information":[ { "code": "3021114", "type": "DRG" } ],"standard_charges":[{"minimum":4116.0000,"maximum":4116.0000,"gross_charge":4116.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Smear, primary source with interpretation; fluorescent and\/or acid fast stain for bacteria, fungi parasites, viruses or cell types","code_information":[ { "code": "87206", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Smear, primary source with interpretation; Gram Stain for bacteria, fungi or cell types","code_information":[ { "code": "87205", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Smear, primary source with interpretation; special stain for inclusion bodies or parasites","code_information":[ { "code": "87207", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Smoke Evacuation Pencil w\/o Extension","code_information":[ { "code": "270000891", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sodium; other source","code_information":[ { "code": "84302", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sodium; serum, plasma or whole blood","code_information":[ { "code": "84295", "type": "DRG" } ],"standard_charges":[{"minimum":100.4600,"maximum":100.4600,"gross_charge":100.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sodium; urine","code_information":[ { "code": "84300", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Soma Sensor Adult","code_information":[ { "code": "430000003", "type": "DRG" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Somatomedin","code_information":[ { "code": "84305", "type": "DRG" } ],"standard_charges":[{"minimum":189.0000,"maximum":189.0000,"gross_charge":189.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":189.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Spectranetics Lead Cutter (X)","code_information":[ { "code": "270000909", "type": "DRG" } ],"standard_charges":[{"minimum":105.8700,"maximum":105.8700,"gross_charge":105.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Spectranetics 518-027 LLD Lead Locking","code_information":[ { "code": "270000911", "type": "DRG" } ],"standard_charges":[{"minimum":105.8700,"maximum":105.8700,"gross_charge":105.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Spectrophotometry, analyte not elsewhere specified","code_information":[ { "code": "84311", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Spinal Needle 22G X 3.50 IN","code_information":[ { "code": "270000913", "type": "DRG" } ],"standard_charges":[{"minimum":91.6300,"maximum":91.6300,"gross_charge":91.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Splenoportography radiological supervision and interpretation","code_information":[ { "code": "75810", "type": "DRG" } ],"standard_charges":[{"minimum":4271.8200,"maximum":4271.8200,"gross_charge":4271.8200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4271.8200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Split Sheath Introducer with Valve 7F","code_information":[ { "code": "270000065", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Split Sheath Introducer with Valve 9F","code_information":[ { "code": "270000067", "type": "DRG" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Splitting of blood or blood products, each unit","code_information":[ { "code": "86985", "type": "DRG" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sprint Quattro Secure MRI SureScan","code_information":[ { "code": "8011692", "type": "DRG" } ],"standard_charges":[{"minimum":1057.0000,"maximum":1057.0000,"gross_charge":1057.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1057.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stab phlebectomy of varicouse veins, 1 extremity; 10-20 stab incisions","code_information":[ { "code": "37765", "type": "DRG" } ],"standard_charges":[{"minimum":365.6000,"maximum":365.6000,"gross_charge":365.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":365.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stage Femoral Cannula","code_information":[ { "code": "2706110", "type": "DRG" } ],"standard_charges":[{"minimum":31.2000,"maximum":31.2000,"gross_charge":31.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Standard Flow","code_information":[ { "code": "2703345", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Staphylococcus aureus, methicilin resistant, amplified probe technique","code_information":[ { "code": "87641", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stapler 30 Curved-Tip","code_information":[ { "code": "3021142", "type": "DRG" } ],"standard_charges":[{"minimum":10584.0000,"maximum":10584.0000,"gross_charge":10584.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10584.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sternal Myo Wire #6","code_information":[ { "code": "2701277", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sternum Saw Blade","code_information":[ { "code": "270001305", "type": "DRG" } ],"standard_charges":[{"minimum":137.2000,"maximum":137.2000,"gross_charge":137.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sternum Suture Kit-Stainless Steel","code_information":[ { "code": "270000923", "type": "DRG" } ],"standard_charges":[{"minimum":44.4500,"maximum":44.4500,"gross_charge":44.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Straight Chest Tube #16 Fr","code_information":[ { "code": "270001307", "type": "DRG" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Straight Chest Tube #20 Fr","code_information":[ { "code": "270001309", "type": "DRG" } ],"standard_charges":[{"minimum":224.0000,"maximum":224.0000,"gross_charge":224.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":224.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Straight Chest Tube #32Fr","code_information":[ { "code": "270001313", "type": "DRG" } ],"standard_charges":[{"minimum":226.8000,"maximum":226.8000,"gross_charge":226.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"STRATAFIX Spiral MOCRYL Plus PS-2-0","code_information":[ { "code": "3021306", "type": "DRG" } ],"standard_charges":[{"minimum":41.7100,"maximum":41.7100,"gross_charge":41.7100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.7100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Streptococcus Group B, amplified probe technique","code_information":[ { "code": "87653", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet 6082-58 STRT EXTD TPR GLBL EIFU","code_information":[ { "code": "2771421", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 58 cm","code_information":[ { "code": "270000939", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 65 cm","code_information":[ { "code": "270000941", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 75cm","code_information":[ { "code": "270000943", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 53 CM","code_information":[ { "code": "270000937", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6054-65 cm Transveus","code_information":[ { "code": "270000069", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6057-58 cm Transveus","code_information":[ { "code": "270000071", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6082-52 cm Transveus","code_information":[ { "code": "270000073", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6082-65 cm Transveus","code_information":[ { "code": "270000075", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6082-75 cm Transveus","code_information":[ { "code": "270000077", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6091-53 cm Transveus","code_information":[ { "code": "270000079", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6093-65 cm Transveus","code_information":[ { "code": "270000081", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Stylet Kit 6094-52 cm Transveus","code_information":[ { "code": "270000083", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Sugars; single qualitative, each specimen","code_information":[ { "code": "84376", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluroscopy, contrast injection, image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; unilateral","code_information":[ { "code": "36253", "type": "DRG" } ],"standard_charges":[{"minimum":471.6600,"maximum":471.6600,"gross_charge":471.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":471.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suprapubic Cystostomy Tray","code_information":[ { "code": "2771356", "type": "DRG" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SureForm 45mm reload Black 4.6mm","code_information":[ { "code": "3021128", "type": "DRG" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SureForm 45mm reload Blue 3.5mm","code_information":[ { "code": "3021130", "type": "DRG" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"SureForm 45mm reload Green 4.3 mm","code_information":[ { "code": "3021129", "type": "DRG" } ],"standard_charges":[{"minimum":294.0000,"maximum":294.0000,"gross_charge":294.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":294.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgical closure tracheostomy or fistula; without plastic repair","code_information":[ { "code": "31820", "type": "DRG" } ],"standard_charges":[{"minimum":469.7600,"maximum":469.7600,"gross_charge":469.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgical steel #4 (Stainless steel)","code_information":[ { "code": "270000975", "type": "DRG" } ],"standard_charges":[{"minimum":150.5800,"maximum":150.5800,"gross_charge":150.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgicel fibrillar 4IN X 4IN","code_information":[ { "code": "270000977", "type": "DRG" } ],"standard_charges":[{"minimum":68.9200,"maximum":68.9200,"gross_charge":68.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgicel Fibrillar Hemostat 1 in x 2","code_information":[ { "code": "270000979", "type": "DRG" } ],"standard_charges":[{"minimum":138.6300,"maximum":138.6300,"gross_charge":138.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":138.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgicel NU-KNIT (3in x 4in)","code_information":[ { "code": "270000981", "type": "DRG" } ],"standard_charges":[{"minimum":195.9400,"maximum":195.9400,"gross_charge":195.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":195.9400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgiflo Hemostatic Matrix","code_information":[ { "code": "270000985", "type": "DRG" } ],"standard_charges":[{"minimum":144.2000,"maximum":144.2000,"gross_charge":144.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Surgifoam","code_information":[ { "code": "270001319", "type": "DRG" } ],"standard_charges":[{"minimum":47.3200,"maximum":47.3200,"gross_charge":47.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Susceptibility studies, antimicrobial agent; agar dilution method, per agent","code_information":[ { "code": "87181", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suture and\/or ligation of thoracic duct; thoracic approach","code_information":[ { "code": "38381", "type": "DRG" } ],"standard_charges":[{"minimum":1117.1600,"maximum":1117.1600,"gross_charge":1117.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1117.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suture of esophageal wound or injury; transthoracic or transabdominal approach","code_information":[ { "code": "43415", "type": "DRG" } ],"standard_charges":[{"minimum":3506.2200,"maximum":3506.2200,"gross_charge":3506.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3506.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suture of tracheal wound or injury; intrathoracic","code_information":[ { "code": "31805", "type": "DRG" } ],"standard_charges":[{"minimum":1134.4600,"maximum":1134.4600,"gross_charge":1134.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1134.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suture Sleeve (Model 6773)","code_information":[ { "code": "270000989", "type": "DRG" } ],"standard_charges":[{"minimum":135.8000,"maximum":135.8000,"gross_charge":135.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":135.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Suture Sleeves (Model 6220)","code_information":[ { "code": "270000991", "type": "DRG" } ],"standard_charges":[{"minimum":74.2000,"maximum":74.2000,"gross_charge":74.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":74.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Syphilis test, non-treponemal antibody; qualitative","code_information":[ { "code": "86592", "type": "DRG" } ],"standard_charges":[{"minimum":20.4400,"maximum":20.4400,"gross_charge":20.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Syphilis test, non-treponemal antibody; quantitative","code_information":[ { "code": "86593", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"T cells absolute CD4","code_information":[ { "code": "86361", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"T cells; absolute cd4 and cd8 count, including ratio","code_information":[ { "code": "86360", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"TA Loading Unit with DST Series","code_information":[ { "code": "3021165", "type": "DRG" } ],"standard_charges":[{"minimum":602.0300,"maximum":602.0300,"gross_charge":602.0300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":602.0300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"TA Stapler with DST Series Techlogy","code_information":[ { "code": "3021164", "type": "DRG" } ],"standard_charges":[{"minimum":1680.0000,"maximum":1680.0000,"gross_charge":1680.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tacrolimus","code_information":[ { "code": "80197", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Talcum Powder","code_information":[ { "code": "250002055", "type": "DRG" } ],"standard_charges":[{"minimum":139.3000,"maximum":139.3000,"gross_charge":139.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Telemetry","code_information":[ { "code": "206000001", "type": "DRG" } ],"standard_charges":[{"minimum":480.7100,"maximum":672.0000,"gross_charge":480.7100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Telescoping Smoke Evacuation Pencil","code_information":[ { "code": "270001001", "type": "DRG" } ],"standard_charges":[{"minimum":205.8000,"maximum":205.8000,"gross_charge":205.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":205.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Temporary Pacing Catheter with","code_information":[ { "code": "270001003", "type": "DRG" } ],"standard_charges":[{"minimum":226.8000,"maximum":226.8000,"gross_charge":226.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":226.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tendril MRI Pacing Lead 52 cm 8F","code_information":[ { "code": "2770422", "type": "DRG" } ],"standard_charges":[{"minimum":833.0000,"maximum":833.0000,"gross_charge":833.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":833.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Testosterone Free","code_information":[ { "code": "84402", "type": "DRG" } ],"standard_charges":[{"minimum":72.8000,"maximum":72.8000,"gross_charge":72.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Testosterone Total","code_information":[ { "code": "84403", "type": "DRG" } ],"standard_charges":[{"minimum":72.8000,"maximum":72.8000,"gross_charge":72.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thal-quick Chest Tube 20fr","code_information":[ { "code": "3006005", "type": "DRG" } ],"standard_charges":[{"minimum":165.2000,"maximum":165.2000,"gross_charge":165.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":165.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thal-quick Chest Tube 28fr","code_information":[ { "code": "3003195", "type": "DRG" } ],"standard_charges":[{"minimum":190.4000,"maximum":190.4000,"gross_charge":190.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":190.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thal-Quick Chest Tube Set 20 Fr \/ 41","code_information":[ { "code": "270001005", "type": "DRG" } ],"standard_charges":[{"minimum":102.7200,"maximum":102.7200,"gross_charge":102.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":102.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thal-Quick Chest Tube Set 32.Fr \/","code_information":[ { "code": "270001007", "type": "DRG" } ],"standard_charges":[{"minimum":42.2800,"maximum":42.2800,"gross_charge":42.2800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.2800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Theophylline","code_information":[ { "code": "80198", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thermodilution 7 Fr (Swan Ganz)","code_information":[ { "code": "2710165", "type": "DRG" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thiamine (Vitamin B1)","code_information":[ { "code": "84425", "type": "DRG" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance","code_information":[ { "code": "32555", "type": "DRG" } ],"standard_charges":[{"minimum":146.7300,"maximum":146.7300,"gross_charge":146.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":146.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracic Vascular Pack (Bundle)","code_information":[ { "code": "270001327", "type": "DRG" } ],"standard_charges":[{"minimum":130.3400,"maximum":130.3400,"gross_charge":130.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":130.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoport Trocar 5.5MM","code_information":[ { "code": "270001329", "type": "DRG" } ],"standard_charges":[{"minimum":44.6600,"maximum":44.6600,"gross_charge":44.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoport Trocar 10.5 MM","code_information":[ { "code": "270001331", "type": "DRG" } ],"standard_charges":[{"minimum":46.0600,"maximum":46.0600,"gross_charge":46.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoport Trocar 11.5MM","code_information":[ { "code": "270001333", "type": "DRG" } ],"standard_charges":[{"minimum":46.0600,"maximum":46.0600,"gross_charge":46.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy with biopsy pleura","code_information":[ { "code": "32609", "type": "DRG" } ],"standard_charges":[{"minimum":345.9300,"maximum":345.9300,"gross_charge":345.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":345.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy with diagnostic biopsy of Lung Infiltrates","code_information":[ { "code": "32607", "type": "DRG" } ],"standard_charges":[{"minimum":415.4200,"maximum":415.4200,"gross_charge":415.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy with diagnostic biopsy of Lung nodules or mass","code_information":[ { "code": "32608", "type": "DRG" } ],"standard_charges":[{"minimum":510.5900,"maximum":510.5900,"gross_charge":510.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":510.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, diagnostic; lungs, pericardial sac, mediastinal or pleural space, without biopsy","code_information":[ { "code": "32601", "type": "DRG" } ],"standard_charges":[{"minimum":416.3500,"maximum":416.3500,"gross_charge":416.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage","code_information":[ { "code": "32659", "type": "DRG" } ],"standard_charges":[{"minimum":1001.0400,"maximum":1001.0400,"gross_charge":1001.0400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1001.0400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with esophagomyotomy","code_information":[ { "code": "32665", "type": "DRG" } ],"standard_charges":[{"minimum":1666.0000,"maximum":1666.0000,"gross_charge":1666.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1666.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with excision of mediastinal cyst, tumor or mass","code_information":[ { "code": "32662", "type": "DRG" } ],"standard_charges":[{"minimum":1215.6600,"maximum":1215.6600,"gross_charge":1215.6600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1215.6600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with excision or pericardial cyst, tumor or mass","code_information":[ { "code": "32661", "type": "DRG" } ],"standard_charges":[{"minimum":1086.9200,"maximum":1086.9200,"gross_charge":1086.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1086.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with lobectomy","code_information":[ { "code": "32663", "type": "DRG" } ],"standard_charges":[{"minimum":1891.2200,"maximum":1891.2200,"gross_charge":1891.2200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1891.2200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy","code_information":[ { "code": "32674", "type": "DRG" } ],"standard_charges":[{"minimum":288.7800,"maximum":288.7800,"gross_charge":288.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with parietal pleurectomy","code_information":[ { "code": "32656", "type": "DRG" } ],"standard_charges":[{"minimum":1093.4800,"maximum":1093.4800,"gross_charge":1093.4800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1093.4800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with partial pulmonary decortication","code_information":[ { "code": "32651", "type": "DRG" } ],"standard_charges":[{"minimum":1485.7900,"maximum":1485.7900,"gross_charge":1485.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1485.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with pleurodesis","code_information":[ { "code": "32650", "type": "DRG" } ],"standard_charges":[{"minimum":926.8700,"maximum":926.8700,"gross_charge":926.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":926.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":911.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with removal of a single lung segment","code_information":[ { "code": "32669", "type": "DRG" } ],"standard_charges":[{"minimum":1816.1600,"maximum":1816.1600,"gross_charge":1816.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1816.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with removal of lung","code_information":[ { "code": "32671", "type": "DRG" } ],"standard_charges":[{"minimum":2432.4200,"maximum":2432.4200,"gross_charge":2432.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2432.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with removal of two lobes","code_information":[ { "code": "32670", "type": "DRG" } ],"standard_charges":[{"minimum":2198.1400,"maximum":2198.1400,"gross_charge":2198.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2198.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral","code_information":[ { "code": "32673", "type": "DRG" } ],"standard_charges":[{"minimum":1646.3600,"maximum":1646.3600,"gross_charge":1646.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1646.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed","code_information":[ { "code": "32655", "type": "DRG" } ],"standard_charges":[{"minimum":1299.9300,"maximum":1299.9300,"gross_charge":1299.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1299.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with therapeutic wedge resection, each additional resection, ipsilateral","code_information":[ { "code": "32667", "type": "DRG" } ],"standard_charges":[{"minimum":210.0700,"maximum":210.0700,"gross_charge":210.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with therapeutic wedge resection, followed by anatomic lung resection","code_information":[ { "code": "32668", "type": "DRG" } ],"standard_charges":[{"minimum":210.0700,"maximum":210.0700,"gross_charge":210.0700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with therapeutic wedge resection, initial unilateral","code_information":[ { "code": "32666", "type": "DRG" } ],"standard_charges":[{"minimum":1183.2000,"maximum":1183.2000,"gross_charge":1183.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1183.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with thoracic sympathectomy","code_information":[ { "code": "32664", "type": "DRG" } ],"standard_charges":[{"minimum":1153.2900,"maximum":1153.2900,"gross_charge":1153.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1153.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis","code_information":[ { "code": "32652", "type": "DRG" } ],"standard_charges":[{"minimum":2250.4400,"maximum":2250.4400,"gross_charge":2250.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2250.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracostomy with rib resection for empyema","code_information":[ { "code": "32035", "type": "DRG" } ],"standard_charges":[{"minimum":1021.7600,"maximum":1021.7600,"gross_charge":1021.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1021.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy with cyst removal, includes pleural procedure when performed","code_information":[ { "code": "32140", "type": "DRG" } ],"standard_charges":[{"minimum":1347.5800,"maximum":1347.5800,"gross_charge":1347.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1347.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy with diagnostic wedge resection followed by anatomic lung resection","code_information":[ { "code": "32507", "type": "DRG" } ],"standard_charges":[{"minimum":209.1600,"maximum":209.1600,"gross_charge":209.1600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.1600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy with resection-plication of bullae, includes any pleural procedure when performed","code_information":[ { "code": "32141", "type": "DRG" } ],"standard_charges":[{"minimum":2057.4300,"maximum":2057.4300,"gross_charge":2057.4300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2057.4300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy with therapeutic wedge resection, initial","code_information":[ { "code": "32505", "type": "DRG" } ],"standard_charges":[{"minimum":1286.1000,"maximum":1286.1000,"gross_charge":1286.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1286.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy with wedge resection, each additional resection, ipsilateral","code_information":[ { "code": "32506", "type": "DRG" } ],"standard_charges":[{"minimum":209.6200,"maximum":209.6200,"gross_charge":209.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy; with control of traumatic hemorrhage and or repair of lung tear","code_information":[ { "code": "32110", "type": "DRG" } ],"standard_charges":[{"minimum":2007.3600,"maximum":2007.3600,"gross_charge":2007.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2007.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy; with diagnostic biopsy of lung nodules or mass","code_information":[ { "code": "32097", "type": "DRG" } ],"standard_charges":[{"minimum":1088.6000,"maximum":1088.6000,"gross_charge":1088.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1088.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thoracotomy; with exploration","code_information":[ { "code": "32100", "type": "DRG" } ],"standard_charges":[{"minimum":1102.9800,"maximum":1102.9800,"gross_charge":1102.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thora-paracentesis tray","code_information":[ { "code": "2704970", "type": "DRG" } ],"standard_charges":[{"minimum":150.0000,"maximum":150.0000,"gross_charge":150.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thrombin Time plasma","code_information":[ { "code": "85670", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thromboendarterectomy, including patch graft, if perfomed; common femoral","code_information":[ { "code": "35371", "type": "DRG" } ],"standard_charges":[{"minimum":1110.7700,"maximum":1110.7700,"gross_charge":1110.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1110.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1092.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thromboendarterectomy, including patch graft, if perfomed; superficial femoral artery","code_information":[ { "code": "35302", "type": "DRG" } ],"standard_charges":[{"minimum":1522.8600,"maximum":1522.8600,"gross_charge":1522.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1522.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thromboendarterectomy, including patch graft, if perfomed; carotid, vertebral, subclavian, by neck incision","code_information":[ { "code": "35301", "type": "DRG" } ],"standard_charges":[{"minimum":1540.2100,"maximum":1540.2100,"gross_charge":1540.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thromboplastin time, partial; plasma or whole blood","code_information":[ { "code": "85730", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thymectomy, partial or total; transcervical approach","code_information":[ { "code": "60520", "type": "DRG" } ],"standard_charges":[{"minimum":1444.8100,"maximum":1444.8100,"gross_charge":1444.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1444.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroglobulin antibody","code_information":[ { "code": "86800", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)","code_information":[ { "code": "84479", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroid stimulating hormone (TSH)","code_information":[ { "code": "84443", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroid Stimulating Immune globulins (TSI)","code_information":[ { "code": "84445", "type": "DRG" } ],"standard_charges":[{"minimum":100.4600,"maximum":100.4600,"gross_charge":100.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroidectomy, total or complete","code_information":[ { "code": "60240", "type": "DRG" } ],"standard_charges":[{"minimum":1265.3100,"maximum":1265.3100,"gross_charge":1265.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1265.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyrotropin releasing hormone (TRH) Stimulating panel; 2 hours","code_information":[ { "code": "80439", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroxine; Free","code_information":[ { "code": "84439", "type": "DRG" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Thyroxine; Total","code_information":[ { "code": "84436", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tiagabine","code_information":[ { "code": "80199", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ti-cron 2-0 36\" Cv305","code_information":[ { "code": "270001335", "type": "DRG" } ],"standard_charges":[{"minimum":58.3300,"maximum":58.3300,"gross_charge":58.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Ti-Cron 2-0 CV-316 10x30\"","code_information":[ { "code": "270001013", "type": "DRG" } ],"standard_charges":[{"minimum":58.3300,"maximum":58.3300,"gross_charge":58.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tissue transglutaminase, each immunoglobulin class","code_information":[ { "code": "86364", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tobramycin","code_information":[ { "code": "80200", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Topiramate","code_information":[ { "code": "80201", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"TorqMAX Sheath Grip","code_information":[ { "code": "2790689", "type": "DRG" } ],"standard_charges":[{"minimum":171.5000,"maximum":171.5000,"gross_charge":171.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":171.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Total or near total esophagectomy, with colo interposition or small intestine recontruction, including intestine mobilization, preparation and anastomosis(es)","code_information":[ { "code": "43108", "type": "DRG" } ],"standard_charges":[{"minimum":6085.0200,"maximum":6085.0200,"gross_charge":6085.0200,"setting":"inpatient","payers_information":[{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6085.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Total or partial esophagectomy, without reconstruction, with cervical esophagostomy","code_information":[ { "code": "43124", "type": "DRG" } ],"standard_charges":[{"minimum":5141.8500,"maximum":5141.8500,"gross_charge":5141.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5141.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Total repair, truncus arteriosus (Rastelli type operation)","code_information":[ { "code": "33786", "type": "DRG" } ],"standard_charges":[{"minimum":3065.7300,"maximum":3065.7300,"gross_charge":3065.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3065.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Toxoplasma","code_information":[ { "code": "86777", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Toxoplasma","code_information":[ { "code": "86778", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"TPW 2-0 24\" Sh TEMPORARY CARDIAC","code_information":[ { "code": "270001337", "type": "DRG" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tracheobronchoscopy through established tracheostomy incision","code_information":[ { "code": "31615", "type": "DRG" } ],"standard_charges":[{"minimum":158.8400,"maximum":158.8400,"gross_charge":158.8400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":158.8400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tracheostomy Tube #4 with cuff","code_information":[ { "code": "2710526", "type": "DRG" } ],"standard_charges":[{"minimum":72.8000,"maximum":72.8000,"gross_charge":72.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tracheostomy Tube #4.5 w\/o cuff","code_information":[ { "code": "2719971", "type": "DRG" } ],"standard_charges":[{"minimum":34.0000,"maximum":34.0000,"gross_charge":34.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tracheostomy Tube-Cuffed 24 Fr","code_information":[ { "code": "270001019", "type": "DRG" } ],"standard_charges":[{"minimum":117.6000,"maximum":117.6000,"gross_charge":117.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":117.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tracheostomy, planned","code_information":[ { "code": "31600", "type": "DRG" } ],"standard_charges":[{"minimum":415.6700,"maximum":415.6700,"gross_charge":415.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":415.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Trancatheter placement of an intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection","code_information":[ { "code": "37215", "type": "DRG" } ],"standard_charges":[{"minimum":1351.6900,"maximum":1351.6900,"gross_charge":1351.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1351.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1329.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatether aortic valve replacement (TAVR\/TAVI) with prosthetic valve; open axillary artery approach","code_information":[ { "code": "33363", "type": "DRG" } ],"standard_charges":[{"minimum":1834.2400,"maximum":1834.2400,"gross_charge":1834.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1834.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatether aortic valve replacement (TAVR\/TAVI) with prosthetic valve; percutaneous femoral artery approach","code_information":[ { "code": "33361", "type": "DRG" } ],"standard_charges":[{"minimum":1621.8700,"maximum":1621.8700,"gross_charge":1621.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1621.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis","code_information":[ { "code": "33418", "type": "DRG" } ],"standard_charges":[{"minimum":2460.5400,"maximum":2460.5400,"gross_charge":2460.5400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2460.5400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter placement of an intravascular stent open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery","code_information":[ { "code": "37236", "type": "DRG" } ],"standard_charges":[{"minimum":597.4900,"maximum":597.4900,"gross_charge":597.4900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":597.4900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":587.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter placement of an intravascular stent, open or percutaneous, including radiological supervision and interpretation and including angioplasty whitin the same vessel, when performed; initial vein","code_information":[ { "code": "37238", "type": "DRG" } ],"standard_charges":[{"minimum":416.1800,"maximum":416.1800,"gross_charge":416.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":416.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation","code_information":[ { "code": "37217", "type": "DRG" } ],"standard_charges":[{"minimum":1469.5500,"maximum":1469.5500,"gross_charge":1469.5500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1469.5500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation","code_information":[ { "code": "37218", "type": "DRG" } ],"standard_charges":[{"minimum":1131.4200,"maximum":1131.4200,"gross_charge":1131.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1131.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed","code_information":[ { "code": "33477", "type": "DRG" } ],"standard_charges":[{"minimum":1758.2700,"maximum":1758.2700,"gross_charge":1758.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1758.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance, when performed","code_information":[ { "code": "33275", "type": "DRG" } ],"standard_charges":[{"minimum":693.1800,"maximum":693.1800,"gross_charge":693.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":693.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day","code_information":[ { "code": "37212", "type": "DRG" } ],"standard_charges":[{"minimum":450.2400,"maximum":450.2400,"gross_charge":450.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":450.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcranial doppler study of the intracranial arteries; complete study","code_information":[ { "code": "93886", "type": "DRG" } ],"standard_charges":[{"minimum":386.4400,"maximum":386.4400,"gross_charge":386.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transcranial doppler study of the intracranial arteries; limited study","code_information":[ { "code": "93888", "type": "DRG" } ],"standard_charges":[{"minimum":227.8500,"maximum":227.8500,"gross_charge":227.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":227.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transducer Triple","code_information":[ { "code": "2703130", "type": "DRG" } ],"standard_charges":[{"minimum":53.2000,"maximum":53.2000,"gross_charge":53.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transetion of pulmonary artery with cardiopulmonary bypass","code_information":[ { "code": "33922", "type": "DRG" } ],"standard_charges":[{"minimum":1884.9500,"maximum":1884.9500,"gross_charge":1884.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1884.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transferase Alanine Amino","code_information":[ { "code": "84460", "type": "DRG" } ],"standard_charges":[{"minimum":28.0000,"maximum":28.0000,"gross_charge":28.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transferrin","code_information":[ { "code": "84466", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transluminal balloon angioplasty, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to performe the angioplasty within the same artery; each additional artery","code_information":[ { "code": "37247", "type": "DRG" } ],"standard_charges":[{"minimum":235.0600,"maximum":235.0600,"gross_charge":235.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transluminal balloon angioplasty, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to performe the angioplasty within the same artery; initial artery","code_information":[ { "code": "37246", "type": "DRG" } ],"standard_charges":[{"minimum":464.3400,"maximum":464.3400,"gross_charge":464.3400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":464.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":472.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transluminal balloon angioplasty, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to performe the angioplasty within the same vein; initial vein","code_information":[ { "code": "37248", "type": "DRG" } ],"standard_charges":[{"minimum":402.9200,"maximum":402.9200,"gross_charge":402.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":402.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":396.3400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Transportation Charge","code_information":[ { "code": "BSSM-48", "type": "DRG" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Treatment left\/right atrial fibrilation additional","code_information":[ { "code": "93657", "type": "DRG" } ],"standard_charges":[{"minimum":410.4200,"maximum":410.4200,"gross_charge":410.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Treatment of superficial wound dehiscence; simple closure","code_information":[ { "code": "12020", "type": "DRG" } ],"standard_charges":[{"minimum":264.2500,"maximum":264.2500,"gross_charge":264.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Treponema pallidum","code_information":[ { "code": "86780", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Trifecta GT Model: TFGT-21A","code_information":[ { "code": "3017495", "type": "DRG" } ],"standard_charges":[{"minimum":4760.0000,"maximum":4760.0000,"gross_charge":4760.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4760.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Triglycerides","code_information":[ { "code": "84478", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Triiodothyronine T3 Free","code_information":[ { "code": "84481", "type": "DRG" } ],"standard_charges":[{"minimum":10.1900,"maximum":10.1900,"gross_charge":10.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Triiodothyronine T3 Reverse","code_information":[ { "code": "84482", "type": "DRG" } ],"standard_charges":[{"minimum":100.4600,"maximum":100.4600,"gross_charge":100.4600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.4600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Triiodothyronine T3 Total","code_information":[ { "code": "84480", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Triple Lumen (Arrowg+ard Blue Plus","code_information":[ { "code": "270001023", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Troponin, quantitative","code_information":[ { "code": "84484", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tru-Cut Biopsy Needles 18G 11.4 cm","code_information":[ { "code": "270001025", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 110cm","code_information":[ { "code": "270001027", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 110cm Catheter Lote","code_information":[ { "code": "2710674", "type": "DRG" } ],"standard_charges":[{"minimum":1487.5000,"maximum":1487.5000,"gross_charge":1487.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1487.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 20mm\/405cm\/110cm 11F","code_information":[ { "code": "270001029", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 21mm\/4.5cm\/110cm 12 F","code_information":[ { "code": "270001031", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 22mm\/4.5cm\/110cm 12F","code_information":[ { "code": "270001033", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 23mm\/4.4cm\/110cm 12 F","code_information":[ { "code": "270001035", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 24mm\/4.5cm\/110cm 12F","code_information":[ { "code": "270001037", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 25mm\/4.5cm\/110cm 13F","code_information":[ { "code": "270001039", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 26mm\/4.5cm\/110cm 13 F","code_information":[ { "code": "270001041", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"True Dilatation 28mm\/4.5cm\/110cm 14 F","code_information":[ { "code": "270001043", "type": "DRG" } ],"standard_charges":[{"minimum":1102.5000,"maximum":1102.5000,"gross_charge":1102.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1102.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tube thoracostomy, includes connection to drainage system when performed, open","code_information":[ { "code": "32551", "type": "DRG" } ],"standard_charges":[{"minimum":213.7900,"maximum":213.7900,"gross_charge":213.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":213.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tuberculosis test, cell mediated immunity antigen response measurement; Gamma interferon","code_information":[ { "code": "86480", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tuberculosis test, cell mediated immunity antigen response measurement; tuberculosis, intradermal","code_information":[ { "code": "86580", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"TYRX Absorbable Antibacterial","code_information":[ { "code": "3020721", "type": "DRG" } ],"standard_charges":[{"minimum":995.0000,"maximum":995.0000,"gross_charge":995.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":995.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Tyshak Ii 8fr.\/22mm\/100cm\/bl5cm","code_information":[ { "code": "2704479", "type": "DRG" } ],"standard_charges":[{"minimum":630.0000,"maximum":630.0000,"gross_charge":630.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Under Endovascular Repair Procedures of the Abdominal Aorta and\/or Iliac Arteries","code_information":[ { "code": "34701", "type": "DRG" } ],"standard_charges":[{"minimum":1652.7700,"maximum":1652.7700,"gross_charge":1652.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1652.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Unify Assura CRT-D","code_information":[ { "code": "3017617", "type": "DRG" } ],"standard_charges":[{"minimum":9982.0000,"maximum":9982.0000,"gross_charge":9982.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9982.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Universal II Slitter 6230UNI","code_information":[ { "code": "270000085", "type": "DRG" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system","code_information":[ { "code": "33214", "type": "DRG" } ],"standard_charges":[{"minimum":647.8900,"maximum":647.8900,"gross_charge":647.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":647.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Upper extremity study - duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study","code_information":[ { "code": "93925", "type": "DRG" } ],"standard_charges":[{"minimum":343.9000,"maximum":343.9000,"gross_charge":343.9000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":343.9000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Upper extremity study - duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study","code_information":[ { "code": "93926", "type": "DRG" } ],"standard_charges":[{"minimum":199.1800,"maximum":199.1800,"gross_charge":199.1800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":199.1800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Upper extremity study - duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study","code_information":[ { "code": "93930", "type": "DRG" } ],"standard_charges":[{"minimum":280.2700,"maximum":280.2700,"gross_charge":280.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urea nitrogen, urine","code_information":[ { "code": "84540", "type": "DRG" } ],"standard_charges":[{"minimum":8.4000,"maximum":8.4000,"gross_charge":8.4000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.4000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urea Nitrogen; quantitative","code_information":[ { "code": "84520", "type": "DRG" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Uric Acid; blood","code_information":[ { "code": "84550", "type": "DRG" } ],"standard_charges":[{"minimum":12.6000,"maximum":12.6000,"gross_charge":12.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Uric Acid; other source","code_information":[ { "code": "84560", "type": "DRG" } ],"standard_charges":[{"minimum":12.6000,"maximum":12.6000,"gross_charge":12.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urinalisys by dip stick or tablet reagent; Automated, with microscopy","code_information":[ { "code": "81001", "type": "DRG" } ],"standard_charges":[{"minimum":14.7100,"maximum":14.7100,"gross_charge":14.7100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urinalisys by dip stick or tablet reagent; Automated, without microscopy","code_information":[ { "code": "81003", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urinalysis; qualitative or semiquantitative, except immunoassays","code_information":[ { "code": "81005", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Urine pregnancy test, by visual color comparison methods","code_information":[ { "code": "81025", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US abdomen","code_information":[ { "code": "76700", "type": "DRG" } ],"standard_charges":[{"minimum":167.5000,"maximum":167.5000,"gross_charge":167.5000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.5000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US abdomen limited","code_information":[ { "code": "76705", "type": "DRG" } ],"standard_charges":[{"minimum":126.4500,"maximum":126.4500,"gross_charge":126.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US abdominal aortic aneurysm","code_information":[ { "code": "76706", "type": "DRG" } ],"standard_charges":[{"minimum":149.9400,"maximum":149.9400,"gross_charge":149.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":153.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US biopsy","code_information":[ { "code": "76942", "type": "DRG" } ],"standard_charges":[{"minimum":82.8900,"maximum":82.8900,"gross_charge":82.8900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US biopsy soft tissue neck","code_information":[ { "code": "76536", "type": "DRG" } ],"standard_charges":[{"minimum":159.9400,"maximum":159.9400,"gross_charge":159.9400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.9400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":159.8800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US bladder","code_information":[ { "code": "76857", "type": "DRG" } ],"standard_charges":[{"minimum":69.5900,"maximum":69.5900,"gross_charge":69.5900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":69.5900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US bone density peripheral","code_information":[ { "code": "76977", "type": "DRG" } ],"standard_charges":[{"minimum":10.2900,"maximum":10.2900,"gross_charge":10.2900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.2900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US breast BI complete","code_information":[ { "code": "76641", "type": "DRG" } ],"standard_charges":[{"minimum":148.3900,"maximum":148.3900,"gross_charge":148.3900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.3900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US breast BI limited","code_information":[ { "code": "76642", "type": "DRG" } ],"standard_charges":[{"minimum":122.1100,"maximum":122.1100,"gross_charge":122.1100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":122.1100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US chest","code_information":[ { "code": "76604", "type": "DRG" } ],"standard_charges":[{"minimum":81.0200,"maximum":81.0200,"gross_charge":81.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US extremity nonvascular","code_information":[ { "code": "76882", "type": "DRG" } ],"standard_charges":[{"minimum":59.9300,"maximum":59.9300,"gross_charge":59.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US gall bladder","code_information":[ { "code": "76770", "type": "DRG" } ],"standard_charges":[{"minimum":156.0400,"maximum":156.0400,"gross_charge":156.0400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.0400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US head\/brain","code_information":[ { "code": "76506", "type": "DRG" } ],"standard_charges":[{"minimum":162.7800,"maximum":162.7800,"gross_charge":162.7800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":162.7800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US hips infant","code_information":[ { "code": "76885", "type": "DRG" } ],"standard_charges":[{"minimum":196.6700,"maximum":196.6700,"gross_charge":196.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":196.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB <= 14 weeks fetus","code_information":[ { "code": "76801", "type": "DRG" } ],"standard_charges":[{"minimum":168.8500,"maximum":168.8500,"gross_charge":168.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":168.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB >= 14 weeks Fetus","code_information":[ { "code": "76802", "type": "DRG" } ],"standard_charges":[{"minimum":87.1500,"maximum":87.1500,"gross_charge":87.1500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":87.1500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB 1T fetal nuc measure","code_information":[ { "code": "76813", "type": "DRG" } ],"standard_charges":[{"minimum":167.8300,"maximum":167.8300,"gross_charge":167.8300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":167.8300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB follow up","code_information":[ { "code": "76816", "type": "DRG" } ],"standard_charges":[{"minimum":156.9800,"maximum":156.9800,"gross_charge":156.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":156.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB limited","code_information":[ { "code": "76815", "type": "DRG" } ],"standard_charges":[{"minimum":116.8600,"maximum":116.8600,"gross_charge":116.8600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.8600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US OB transvaginal","code_information":[ { "code": "76817", "type": "DRG" } ],"standard_charges":[{"minimum":133.0800,"maximum":133.0800,"gross_charge":133.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":133.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US pelvic complete","code_information":[ { "code": "76856", "type": "DRG" } ],"standard_charges":[{"minimum":151.7600,"maximum":151.7600,"gross_charge":151.7600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":151.7600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US prostate volume","code_information":[ { "code": "76873", "type": "DRG" } ],"standard_charges":[{"minimum":249.4200,"maximum":249.4200,"gross_charge":249.4200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.4200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US renal doppler","code_information":[ { "code": "76776", "type": "DRG" } ],"standard_charges":[{"minimum":212.9300,"maximum":212.9300,"gross_charge":212.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":212.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US retroperitoneal limited","code_information":[ { "code": "76775", "type": "DRG" } ],"standard_charges":[{"minimum":84.3600,"maximum":84.3600,"gross_charge":84.3600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.3600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US scrotum","code_information":[ { "code": "76870", "type": "DRG" } ],"standard_charges":[{"minimum":145.0800,"maximum":145.0800,"gross_charge":145.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"US transvaginal","code_information":[ { "code": "76830", "type": "DRG" } ],"standard_charges":[{"minimum":172.3100,"maximum":172.3100,"gross_charge":172.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":172.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valproic acid; free","code_information":[ { "code": "80165", "type": "DRG" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valproic acid; total","code_information":[ { "code": "80164", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvotomy, pulmonary valve, closed heart, via pulmonary artery","code_information":[ { "code": "33471", "type": "DRG" } ],"standard_charges":[{"minimum":1826.4400,"maximum":1826.4400,"gross_charge":1826.4400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1826.4400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass","code_information":[ { "code": "33474", "type": "DRG" } ],"standard_charges":[{"minimum":2940.7400,"maximum":2940.7400,"gross_charge":2940.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2940.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple","code_information":[ { "code": "33390", "type": "DRG" } ],"standard_charges":[{"minimum":2586.6000,"maximum":2586.6000,"gross_charge":2586.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2586.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvuloplasty, mitral valve, with cardiopulmonary bypass","code_information":[ { "code": "33425", "type": "DRG" } ],"standard_charges":[{"minimum":3673.8700,"maximum":3673.8700,"gross_charge":3673.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3673.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvuloplasty, tricuspid valve; with ring insertion","code_information":[ { "code": "33464", "type": "DRG" } ],"standard_charges":[{"minimum":3280.3800,"maximum":3280.3800,"gross_charge":3280.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3280.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Valvuloplasty, tricuspid valve; without ring insertion","code_information":[ { "code": "33463", "type": "DRG" } ],"standard_charges":[{"minimum":4134.6500,"maximum":4134.6500,"gross_charge":4134.6500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4134.6500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vancomycin","code_information":[ { "code": "80202", "type": "DRG" } ],"standard_charges":[{"minimum":61.0000,"maximum":61.0000,"gross_charge":61.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vanillymandelic acid urine","code_information":[ { "code": "84585", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Varicella zoster","code_information":[ { "code": "86787", "type": "DRG" } ],"standard_charges":[{"minimum":81.2000,"maximum":81.2000,"gross_charge":81.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Varicella Zoster Direct FA","code_information":[ { "code": "87290", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vascular Access System (ELLIPSYS)","code_information":[ { "code": "270001343", "type": "DRG" } ],"standard_charges":[{"minimum":7014.0000,"maximum":7014.0000,"gross_charge":7014.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage","code_information":[ { "code": "37241", "type": "DRG" } ],"standard_charges":[{"minimum":569.5200,"maximum":569.5200,"gross_charge":569.5200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":569.5200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":578.9700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vascular ProGlide 6Fr.(2.oomm)","code_information":[ { "code": "3020151", "type": "DRG" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vascular Stent System SFA and ILIAC","code_information":[ { "code": "4801039", "type": "DRG" } ],"standard_charges":[{"minimum":500.0000,"maximum":500.0000,"gross_charge":500.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vegram Ballon Catheter Attain","code_information":[ { "code": "270000087", "type": "DRG" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vegram Balloon Catheter","code_information":[ { "code": "270001061", "type": "DRG" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vein Pick (Model 6541)","code_information":[ { "code": "270001059", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VenaSeal Closure System","code_information":[ { "code": "270001345", "type": "DRG" } ],"standard_charges":[{"minimum":1680.0000,"maximum":1680.0000,"gross_charge":1680.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venipuncture, cuntdown; age 1 or over","code_information":[ { "code": "36425", "type": "DRG" } ],"standard_charges":[{"minimum":53.6300,"maximum":53.6300,"gross_charge":53.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography- caval, inferior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75825", "type": "DRG" } ],"standard_charges":[{"minimum":157.3300,"maximum":157.3300,"gross_charge":157.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":157.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography- caval, superior, with serialography, radiological supervision and interpretation","code_information":[ { "code": "75827", "type": "DRG" } ],"standard_charges":[{"minimum":163.8100,"maximum":163.8100,"gross_charge":163.8100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":163.8100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Adrenal,Bilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75842", "type": "DRG" } ],"standard_charges":[{"minimum":219.1400,"maximum":219.1400,"gross_charge":219.1400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":219.1400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Adrenal,Unilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75840", "type": "DRG" } ],"standard_charges":[{"minimum":177.2700,"maximum":177.2700,"gross_charge":177.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":177.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Extremity, Bilateral, radiological supervision and interpretation","code_information":[ { "code": "75822", "type": "DRG" } ],"standard_charges":[{"minimum":184.0200,"maximum":184.0200,"gross_charge":184.0200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":184.0200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Extremity, Unilateral, radiological supervision and interpretation","code_information":[ { "code": "75820", "type": "DRG" } ],"standard_charges":[{"minimum":148.6700,"maximum":148.6700,"gross_charge":148.6700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.6700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Renal, Bilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75833", "type": "DRG" } ],"standard_charges":[{"minimum":204.2500,"maximum":204.2500,"gross_charge":204.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":204.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venography-Renal, Unilateral, selective, radiological supervision and intepretation","code_information":[ { "code": "75831", "type": "DRG" } ],"standard_charges":[{"minimum":164.7700,"maximum":164.7700,"gross_charge":164.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":164.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Venous sampling through catheter, with or without angiography, radiological supervision and interpretation","code_information":[ { "code": "75893", "type": "DRG" } ],"standard_charges":[{"minimum":145.1700,"maximum":145.1700,"gross_charge":145.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VersaCross Connect LAAC Access","code_information":[ { "code": "3021220", "type": "DRG" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021166", "type": "DRG" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021167", "type": "DRG" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vesseal Sealer Extend","code_information":[ { "code": "3021112", "type": "DRG" } ],"standard_charges":[{"minimum":918.8700,"maximum":918.8700,"gross_charge":918.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Veus Cannula 32\/40 Fr","code_information":[ { "code": "2702630", "type": "DRG" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Veus Cannula Pediatric","code_information":[ { "code": "2702625", "type": "DRG" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VIABAHN BX BALLOON EXP ENDO 8mmX59mm","code_information":[ { "code": "3021051", "type": "DRG" } ],"standard_charges":[{"minimum":5653.2000,"maximum":5653.2000,"gross_charge":5653.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VIABAHN SX ENDO 35 RO 5mmX5cm 7Fr","code_information":[ { "code": "3020841", "type": "DRG" } ],"standard_charges":[{"minimum":3544.8000,"maximum":3544.8000,"gross_charge":3544.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Virus Isolation; tissue culture inoculation, observation and presumptive identification by cytopathic effect","code_information":[ { "code": "87252", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Viscosity","code_information":[ { "code": "85810", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Visi Sheath L 23cm","code_information":[ { "code": "2800730", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Visionist CRT-P U225","code_information":[ { "code": "3021096", "type": "DRG" } ],"standard_charges":[{"minimum":2590.0000,"maximum":2590.0000,"gross_charge":2590.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2590.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VisiSheath Dilator Sheath Size L\/ 33cm","code_information":[ { "code": "270001089", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"VisiSheath Dilator Sheath Size M\/ 33cm","code_information":[ { "code": "270001091", "type": "DRG" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vista Brite Tip Guiding Catheter 6F","code_information":[ { "code": "270001093", "type": "DRG" } ],"standard_charges":[{"minimum":147.9900,"maximum":147.9900,"gross_charge":147.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vitamin A","code_information":[ { "code": "84590", "type": "DRG" } ],"standard_charges":[{"minimum":50.7000,"maximum":50.7000,"gross_charge":50.7000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":50.7000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vitamin D; 25 hydroxy, includes fraction(s), if performed","code_information":[ { "code": "82306", "type": "DRG" } ],"standard_charges":[{"minimum":144.2000,"maximum":16.7100,"gross_charge":144.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vitamin E","code_information":[ { "code": "84446", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Vitamin K","code_information":[ { "code": "84597", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"V-Loc 0 3.5 6\" 15cm Blue","code_information":[ { "code": "3021174", "type": "DRG" } ],"standard_charges":[{"minimum":392.0000,"maximum":392.0000,"gross_charge":392.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Volume measurement for timed collection, each","code_information":[ { "code": "81050", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"WATCHMAN FXD CURVE Access System Doble","code_information":[ { "code": "3017696", "type": "DRG" } ],"standard_charges":[{"minimum":21000.0000,"maximum":21000.0000,"gross_charge":21000.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21000.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Webster Electrophysiology Catheter 110","code_information":[ { "code": "270001099", "type": "DRG" } ],"standard_charges":[{"minimum":1205.7500,"maximum":1205.7500,"gross_charge":1205.7500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.7500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"West Nile Virus IgM Antibody","code_information":[ { "code": "86788", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"West Nile Virus IgM Antibody","code_information":[ { "code": "86789", "type": "DRG" } ],"standard_charges":[{"minimum":155.7900,"maximum":155.7900,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":155.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Whole blood , leukocytes reduced, irradiated, each unit","code_information":[ { "code": "P9056", "type": "DRG" } ],"standard_charges":[{"minimum":235.0000,"maximum":235.0000,"gross_charge":235.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Wrench KIT 5873W","code_information":[ { "code": "270000089", "type": "DRG" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Bone age studies","code_information":[ { "code": "77072", "type": "DRG" } ],"standard_charges":[{"minimum":37.2100,"maximum":37.2100,"gross_charge":37.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Manual application of stress performed by physician or other qualified health care professional for joint radiography, including the contralateral joint if indicated","code_information":[ { "code": "77071", "type": "DRG" } ],"standard_charges":[{"minimum":78.1900,"maximum":78.1900,"gross_charge":78.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination from the nose to the rectum for foreign body, single view, child","code_information":[ { "code": "76010", "type": "DRG" } ],"standard_charges":[{"minimum":42.9500,"maximum":42.9500,"gross_charge":42.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination of the skull, complete, minimum of 4 views","code_information":[ { "code": "70260", "type": "DRG" } ],"standard_charges":[{"minimum":63.9500,"maximum":63.9500,"gross_charge":63.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, abdomen; 1 view","code_information":[ { "code": "74018", "type": "DRG" } ],"standard_charges":[{"minimum":42.9500,"maximum":42.9500,"gross_charge":42.9500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.9500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, abdomen; 2 views","code_information":[ { "code": "74019", "type": "DRG" } ],"standard_charges":[{"minimum":52.9800,"maximum":52.9800,"gross_charge":52.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, ankle; 2 views","code_information":[ { "code": "73600", "type": "DRG" } ],"standard_charges":[{"minimum":46.7900,"maximum":46.7900,"gross_charge":46.7900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, both knees, standing, anteroposterior view","code_information":[ { "code": "73565", "type": "DRG" } ],"standard_charges":[{"minimum":57.3000,"maximum":57.3000,"gross_charge":57.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen(eg, supine, erect, decubits), and a single view chest.","code_information":[ { "code": "74022", "type": "DRG" } ],"standard_charges":[{"minimum":71.5800,"maximum":71.5800,"gross_charge":71.5800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":71.5800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, complete, minimum of 3 views","code_information":[ { "code": "73110", "type": "DRG" } ],"standard_charges":[{"minimum":58.7300,"maximum":58.7300,"gross_charge":58.7300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, elbow; 2 views","code_information":[ { "code": "73070", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, elbow; complete, minimum of 3 views","code_information":[ { "code": "73080", "type": "DRG" } ],"standard_charges":[{"minimum":46.7700,"maximum":46.7700,"gross_charge":46.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, facial bones; complete, minimum of 3 views","code_information":[ { "code": "70150", "type": "DRG" } ],"standard_charges":[{"minimum":67.3100,"maximum":67.3100,"gross_charge":67.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, facial bones; less than 3 views","code_information":[ { "code": "70140", "type": "DRG" } ],"standard_charges":[{"minimum":46.3000,"maximum":46.3000,"gross_charge":46.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, femur, minimum 2 views","code_information":[ { "code": "73552", "type": "DRG" } ],"standard_charges":[{"minimum":38.7200,"maximum":38.7200,"gross_charge":38.7200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":38.7200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, finger(s), minimum of 2 views","code_information":[ { "code": "73140", "type": "DRG" } ],"standard_charges":[{"minimum":54.4500,"maximum":54.4500,"gross_charge":54.4500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.4500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, foot; 2 views","code_information":[ { "code": "73620", "type": "DRG" } ],"standard_charges":[{"minimum":40.5600,"maximum":40.5600,"gross_charge":40.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, foot; complete, minimum of 3 views","code_information":[ { "code": "73630", "type": "DRG" } ],"standard_charges":[{"minimum":49.1700,"maximum":49.1700,"gross_charge":49.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, hand; 2 views","code_information":[ { "code": "73120", "type": "DRG" } ],"standard_charges":[{"minimum":44.8700,"maximum":44.8700,"gross_charge":44.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, hand; minimum of 3 views","code_information":[ { "code": "73130", "type": "DRG" } ],"standard_charges":[{"minimum":52.9900,"maximum":52.9900,"gross_charge":52.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, hip, unilateral, with the pelvis when performed; 1 views","code_information":[ { "code": "73501", "type": "DRG" } ],"standard_charges":[{"minimum":47.2500,"maximum":47.2500,"gross_charge":47.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, hip, unilateral, with the pelvis when performed; 2-3 views","code_information":[ { "code": "73502", "type": "DRG" } ],"standard_charges":[{"minimum":67.3300,"maximum":67.3300,"gross_charge":67.3300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":67.3300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, hips, bilateral, with pelvis when performed, 2 views","code_information":[ { "code": "73521", "type": "DRG" } ],"standard_charges":[{"minimum":59.1900,"maximum":59.1900,"gross_charge":59.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, humerus, minimum of 2 views","code_information":[ { "code": "73060", "type": "DRG" } ],"standard_charges":[{"minimum":46.3000,"maximum":46.3000,"gross_charge":46.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, knee, 1 or 2 views","code_information":[ { "code": "73560", "type": "DRG" } ],"standard_charges":[{"minimum":49.1700,"maximum":49.1700,"gross_charge":49.1700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.1700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, knee, 3 views","code_information":[ { "code": "73562", "type": "DRG" } ],"standard_charges":[{"minimum":58.2500,"maximum":58.2500,"gross_charge":58.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, knee; complete, 4 or more views","code_information":[ { "code": "73564", "type": "DRG" } ],"standard_charges":[{"minimum":66.8500,"maximum":66.8500,"gross_charge":66.8500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":66.8500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, mandible; Complete, less than 4 views","code_information":[ { "code": "70110", "type": "DRG" } ],"standard_charges":[{"minimum":62.0500,"maximum":62.0500,"gross_charge":62.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, mandible; partial, less than 4 views","code_information":[ { "code": "70100", "type": "DRG" } ],"standard_charges":[{"minimum":55.3800,"maximum":55.3800,"gross_charge":55.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, mastoids, complete, minimum 3 views per side","code_information":[ { "code": "70130", "type": "DRG" } ],"standard_charges":[{"minimum":89.7400,"maximum":89.7400,"gross_charge":89.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":89.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, mastoids, less than 3 views per side.","code_information":[ { "code": "70120", "type": "DRG" } ],"standard_charges":[{"minimum":55.3800,"maximum":55.3800,"gross_charge":55.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":55.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, nasal bones, complete, minimum of 3 views","code_information":[ { "code": "70160", "type": "DRG" } ],"standard_charges":[{"minimum":54.9100,"maximum":54.9100,"gross_charge":54.9100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":54.9100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, orbits, complete, minimum of 4 views","code_information":[ { "code": "70200", "type": "DRG" } ],"standard_charges":[{"minimum":68.7400,"maximum":68.7400,"gross_charge":68.7400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":68.7400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, osseous survey, infant","code_information":[ { "code": "77076", "type": "DRG" } ],"standard_charges":[{"minimum":37.2100,"maximum":37.2100,"gross_charge":37.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, pelvis; 1 or 2 views","code_information":[ { "code": "72170", "type": "DRG" } ],"standard_charges":[{"minimum":40.0800,"maximum":40.0800,"gross_charge":40.0800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, pelvis; complete, minimum of 3 views","code_information":[ { "code": "72190", "type": "DRG" } ],"standard_charges":[{"minimum":60.6200,"maximum":60.6200,"gross_charge":60.6200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, ribs, bilateral; 3 views","code_information":[ { "code": "71110", "type": "DRG" } ],"standard_charges":[{"minimum":62.9900,"maximum":62.9900,"gross_charge":62.9900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.9900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views","code_information":[ { "code": "71101", "type": "DRG" } ],"standard_charges":[{"minimum":60.6100,"maximum":60.6100,"gross_charge":60.6100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.6100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sacroiliac joints; 3 or more views","code_information":[ { "code": "72202", "type": "DRG" } ],"standard_charges":[{"minimum":56.3200,"maximum":56.3200,"gross_charge":56.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sacroiliac joints; using less than 3 views","code_information":[ { "code": "72200", "type": "DRG" } ],"standard_charges":[{"minimum":47.2500,"maximum":47.2500,"gross_charge":47.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sacrum and coccyx, minimum of 2 views","code_information":[ { "code": "72220", "type": "DRG" } ],"standard_charges":[{"minimum":46.7700,"maximum":46.7700,"gross_charge":46.7700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.7700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, scapula, complete","code_information":[ { "code": "73010", "type": "DRG" } ],"standard_charges":[{"minimum":33.8700,"maximum":33.8700,"gross_charge":33.8700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.8700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, shoulder; 1 view","code_information":[ { "code": "73020", "type": "DRG" } ],"standard_charges":[{"minimum":31.0100,"maximum":31.0100,"gross_charge":31.0100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":31.0100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, shoulder; complete, minimum of 2 views","code_information":[ { "code": "73030", "type": "DRG" } ],"standard_charges":[{"minimum":49.6400,"maximum":49.6400,"gross_charge":49.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sinuses, paranasal, complete, minimum of 3 views","code_information":[ { "code": "70220", "type": "DRG" } ],"standard_charges":[{"minimum":53.9300,"maximum":53.9300,"gross_charge":53.9300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.9300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sinuses, paranasal, less than 3 views","code_information":[ { "code": "70210", "type": "DRG" } ],"standard_charges":[{"minimum":46.3000,"maximum":46.3000,"gross_charge":46.3000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.3000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, skull; less than 4 views","code_information":[ { "code": "70250", "type": "DRG" } ],"standard_charges":[{"minimum":51.5600,"maximum":51.5600,"gross_charge":51.5600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.5600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, cervical; 2 or 3 views","code_information":[ { "code": "72040", "type": "DRG" } ],"standard_charges":[{"minimum":56.8000,"maximum":56.8000,"gross_charge":56.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, cervical; 4 or 5 views","code_information":[ { "code": "72050", "type": "DRG" } ],"standard_charges":[{"minimum":76.3800,"maximum":76.3800,"gross_charge":76.3800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":76.3800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view","code_information":[ { "code": "72081", "type": "DRG" } ],"standard_charges":[{"minimum":61.1000,"maximum":61.1000,"gross_charge":61.1000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, lumbosacral; 2 or 3 views","code_information":[ { "code": "72100", "type": "DRG" } ],"standard_charges":[{"minimum":57.2700,"maximum":57.2700,"gross_charge":57.2700,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.2700,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views","code_information":[ { "code": "72120", "type": "DRG" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, lumbosacral; minimum of 4 views","code_information":[ { "code": "72110", "type": "DRG" } ],"standard_charges":[{"minimum":73.5300,"maximum":73.5300,"gross_charge":73.5300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":73.5300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine, single view, specify level","code_information":[ { "code": "72020", "type": "DRG" } ],"standard_charges":[{"minimum":35.3100,"maximum":35.3100,"gross_charge":35.3100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.3100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine; thoracic, 2 views","code_information":[ { "code": "72070", "type": "DRG" } ],"standard_charges":[{"minimum":47.2500,"maximum":47.2500,"gross_charge":47.2500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.2500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, spine; thoracic, 3 views","code_information":[ { "code": "72072", "type": "DRG" } ],"standard_charges":[{"minimum":56.3200,"maximum":56.3200,"gross_charge":56.3200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.3200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sternoclavicular joint or joints, minimum of 3 views","code_information":[ { "code": "71130", "type": "DRG" } ],"standard_charges":[{"minimum":59.1900,"maximum":59.1900,"gross_charge":59.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, sternum, minimum of 2 views","code_information":[ { "code": "71120", "type": "DRG" } ],"standard_charges":[{"minimum":48.2000,"maximum":48.2000,"gross_charge":48.2000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.2000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, temporomandibular joint (TMJ), open and closed mouth; bilateral","code_information":[ { "code": "70330", "type": "DRG" } ],"standard_charges":[{"minimum":75.9200,"maximum":75.9200,"gross_charge":75.9200,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.9200,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, temporomandibular joint (TMJ), open and closed mouth; unilateral","code_information":[ { "code": "70328", "type": "DRG" } ],"standard_charges":[{"minimum":49.6400,"maximum":49.6400,"gross_charge":49.6400,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6400,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, thoracolumbar junction, minimum of 2 views","code_information":[ { "code": "72080", "type": "DRG" } ],"standard_charges":[{"minimum":49.6300,"maximum":49.6300,"gross_charge":49.6300,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.6300,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, toe(s), minimum of 2 views","code_information":[ { "code": "73660", "type": "DRG" } ],"standard_charges":[{"minimum":42.0600,"maximum":42.0600,"gross_charge":42.0600,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0600,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination, wrist, 2 views","code_information":[ { "code": "73100", "type": "DRG" } ],"standard_charges":[{"minimum":48.6900,"maximum":48.6900,"gross_charge":48.6900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.6900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; calcaneus, minimum of 2 views","code_information":[ { "code": "73650", "type": "DRG" } ],"standard_charges":[{"minimum":41.0500,"maximum":41.0500,"gross_charge":41.0500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":41.0500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; chest, 2 views","code_information":[ { "code": "71046", "type": "DRG" } ],"standard_charges":[{"minimum":48.1900,"maximum":48.1900,"gross_charge":48.1900,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.1900,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; chest, single view","code_information":[ { "code": "71045", "type": "DRG" } ],"standard_charges":[{"minimum":37.2100,"maximum":37.2100,"gross_charge":37.2100,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.2100,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; forearm, 2 views","code_information":[ { "code": "73090", "type": "DRG" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; lower extremity, infants, minimum of 2 views","code_information":[ { "code": "73592", "type": "DRG" } ],"standard_charges":[{"minimum":45.3500,"maximum":45.3500,"gross_charge":45.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; neck, soft tissue","code_information":[ { "code": "70360", "type": "DRG" } ],"standard_charges":[{"minimum":45.3500,"maximum":45.3500,"gross_charge":45.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; ribs, unilateral; 2 views","code_information":[ { "code": "71100", "type": "DRG" } ],"standard_charges":[{"minimum":52.9800,"maximum":52.9800,"gross_charge":52.9800,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.9800,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; tibia and fibula, 2 views","code_information":[ { "code": "73590", "type": "DRG" } ],"standard_charges":[{"minimum":45.3500,"maximum":45.3500,"gross_charge":45.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiologic examination; upper extremity, infants, minimum of 2 views","code_information":[ { "code": "73092", "type": "DRG" } ],"standard_charges":[{"minimum":45.3500,"maximum":45.3500,"gross_charge":45.3500,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.3500,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"XR Radiological examination, spine lumbosacral; complete, including bending views, minimum of 6 views","code_information":[ { "code": "72114", "type": "DRG" } ],"standard_charges":[{"minimum":88.8000,"maximum":88.8000,"gross_charge":88.8000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":88.8000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Zero Tip Smaller Basket Airway","code_information":[ { "code": "270001347", "type": "DRG" } ],"standard_charges":[{"minimum":418.6000,"maximum":418.6000,"gross_charge":418.6000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":418.6000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Zinc","code_information":[ { "code": "84630", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"Zonisamide","code_information":[ { "code": "80203", "type": "DRG" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Humana Gold Plus","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"MMM","plan_name":"MMM Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Tricare","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"},{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"other"}],"additional_generic_notes":"Could be billed separately"}]},{"description":"AMINOPHYLLINE 250MG VIAL","code_information":[ { "code": "J0280", "type": "HCPCS" } ],"standard_charges":[{"minimum":18.5800,"maximum":18.5800,"gross_charge":18.5800,"setting":"both","payers_information":[{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.5800,"methodology":"fee schedule"}]}]},{"description":"ER Cardio Evaluation","code_information":[ { "code": "G0463", "type": "HCPCS" } ],"standard_charges":[{"minimum":288.5000,"maximum":288.5000,"gross_charge":288.5000,"setting":"inpatient","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Humana Gold","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare A","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"},{"payer_name":"Medicare","plan_name":"Medicare B","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"}]}]},{"description":"ER Cardio Evaluation","code_information":[ { "code": "G0464", "type": "HCPCS" } ],"standard_charges":[{"minimum":288.5000,"maximum":288.5000,"gross_charge":288.5000,"setting":"inpatient","payers_information":[{"payer_name":"Triple S","plan_name":"Triple S Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":288.5000,"methodology":"fee schedule"}]}]},{"description":"Injection, dipyridamole, per 10 mg","code_information":[ { "code": "J1245", "type": "HCPCS" } ],"standard_charges":[{"minimum":30.8000,"maximum":30.8000,"gross_charge":30.8000,"setting":"both","payers_information":[{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.8000,"methodology":"fee schedule"}]}]},{"description":"MR Magnetic resonance cholangiopancreatography (MRCP)","code_information":[ { "code": "S8037", "type": "HCPCS" } ],"standard_charges":[{"minimum":506.3800,"maximum":312.5000,"gross_charge":506.3800,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":506.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":506.3800,"methodology":"fee schedule"}]}]},{"description":"Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zones; abnormal native connections","code_information":[ { "code": "93597", "type": "HCPCS" } ],"standard_charges":[{"minimum":1690.7500,"maximum":2534.6500,"gross_charge":1690.7500,"setting":"both","payers_information":[{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":1690.7500,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFDECORTICATION,PULMON\"","code_information":[ { "code": "975000005", "type": "LOCAL" } ],"standard_charges":[{"minimum":1111.5000,"maximum":1111.5000,"gross_charge":1111.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1111.5000,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFREPLAC,TRIC VALV CPB\"","code_information":[ { "code": "975000037", "type": "LOCAL" } ],"standard_charges":[{"minimum":1828.1300,"maximum":1828.1300,"gross_charge":1828.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1828.1300,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFTHYMECTOMY,PARTTOTAL\"","code_information":[ { "code": "975000081", "type": "LOCAL" } ],"standard_charges":[{"minimum":882.0000,"maximum":882.0000,"gross_charge":882.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFTHYROIDECTOMY,TRANSTHO\"","code_information":[ { "code": "975000079", "type": "LOCAL" } ],"standard_charges":[{"minimum":860.0000,"maximum":860.0000,"gross_charge":860.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":860.0000,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFVALVUL,MIT ,RAD RECONS\"","code_information":[ { "code": "975000029", "type": "LOCAL" } ],"standard_charges":[{"minimum":2588.6300,"maximum":2588.6300,"gross_charge":2588.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2588.6300,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFVALVULOP,MIT PROS RING\"","code_information":[ { "code": "975000027", "type": "LOCAL" } ],"standard_charges":[{"minimum":2544.7500,"maximum":2544.7500,"gross_charge":2544.7500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2544.7500,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFVALVULOP,TRIC;WIO RING\"","code_information":[ { "code": "975000033", "type": "LOCAL" } ],"standard_charges":[{"minimum":1667.2500,"maximum":1667.2500,"gross_charge":1667.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1667.2500,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFVALVULOPL,TRIC;WI RING\"","code_information":[ { "code": "975000035", "type": "LOCAL" } ],"standard_charges":[{"minimum":1755.0000,"maximum":1755.0000,"gross_charge":1755.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1755.0000,"methodology":"fee schedule"}]}]},{"description":"\"C.PROFVALVULOPSTY,MITWI CPB\"","code_information":[ { "code": "975000025", "type": "LOCAL" } ],"standard_charges":[{"minimum":1540.5000,"maximum":1540.5000,"gross_charge":1540.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.5000,"methodology":"fee schedule"}]}]},{"description":"\"C.PROREMOVAL LUNG,SING LOBE\"","code_information":[ { "code": "975000007", "type": "LOCAL" } ],"standard_charges":[{"minimum":454.2900,"maximum":454.2900,"gross_charge":454.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":454.2900,"methodology":"fee schedule"}]}]},{"description":"\"Y\" Connector 1\/2 X 1\/2 X 1\/2","code_information":[ { "code": "2702675", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.0200,"maximum":6.0200,"gross_charge":6.0200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"}]}]},{"description":"0.45% Sodium Chloride Injection USP","code_information":[ { "code": "270000091", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.3800,"maximum":2.3800,"gross_charge":2.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"}]}]},{"description":"0.9NS 250ML","code_information":[ { "code": "2701827", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.7200,"maximum":0.7200,"gross_charge":0.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.7200,"methodology":"fee schedule"}]}]},{"description":"1 Red Blood Cell Ag Neg\/Unit: 86902","code_information":[ { "code": "86902", "type": "LOCAL" } ],"standard_charges":[{"minimum":97.0000,"maximum":97.0000,"gross_charge":97.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":97.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":169.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":267.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":388.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":482.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":579.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":723.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":844.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":965.0000,"methodology":"fee schedule"}]}]},{"description":"1\/2 Tubing X 3\/32 X 6FT","code_information":[ { "code": "2704335", "type": "LOCAL" } ],"standard_charges":[{"minimum":25.0000,"maximum":25.0000,"gross_charge":25.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":25.0000,"methodology":"fee schedule"}]}]},{"description":"12 mm & Stapler Bladeless Obturator","code_information":[ { "code": "3021135", "type": "LOCAL" } ],"standard_charges":[{"minimum":1205.4000,"maximum":1205.4000,"gross_charge":1205.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1205.4000,"methodology":"fee schedule"}]}]},{"description":"12 mm & Stapler Cannula Seal","code_information":[ { "code": "3021132", "type": "LOCAL" } ],"standard_charges":[{"minimum":29.4000,"maximum":29.4000,"gross_charge":29.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.4000,"methodology":"fee schedule"}]}]},{"description":"12 mm & Stapler Cannula, Long","code_information":[ { "code": "3021136", "type": "LOCAL" } ],"standard_charges":[{"minimum":1911.0000,"maximum":1911.0000,"gross_charge":1911.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1911.0000,"methodology":"fee schedule"}]}]},{"description":"12-8 mm Reducer","code_information":[ { "code": "3021133", "type": "LOCAL" } ],"standard_charges":[{"minimum":36.8700,"maximum":36.8700,"gross_charge":36.8700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":36.8700,"methodology":"fee schedule"}]}]},{"description":"2 Basin Set with Graduated PK","code_information":[ { "code": "270000093", "type": "LOCAL" } ],"standard_charges":[{"minimum":82.2100,"maximum":82.2100,"gross_charge":82.2100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.2100,"methodology":"fee schedule"}]}]},{"description":"25% Mannitol Injection, USP 12.5g\/50mL","code_information":[ { "code": "250001331", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0700,"maximum":0.0700,"gross_charge":0.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"}]}]},{"description":"3 Way Stop Cock w\/Swivel Male Luer","code_information":[ { "code": "270000095", "type": "LOCAL" } ],"standard_charges":[{"minimum":64.4000,"maximum":64.4000,"gross_charge":64.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":64.4000,"methodology":"fee schedule"}]}]},{"description":"5% Dextrose Injection USP Container","code_information":[ { "code": "270000097", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.3300,"maximum":3.3300,"gross_charge":3.3300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3300,"methodology":"fee schedule"}]}]},{"description":"5071-35 cm Sutureless, unipolar,","code_information":[ { "code": "2711235", "type": "LOCAL" } ],"standard_charges":[{"minimum":315.0000,"maximum":315.0000,"gross_charge":315.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":315.0000,"methodology":"fee schedule"}]}]},{"description":"5-8 mm Cannula Seal","code_information":[ { "code": "3021120", "type": "LOCAL" } ],"standard_charges":[{"minimum":26.4600,"maximum":26.4600,"gross_charge":26.4600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.4600,"methodology":"fee schedule"}]}]},{"description":"5833SL Disposable Surgical Cable. One","code_information":[ { "code": "270000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"7-Band Ligator (Speed Band Superview","code_information":[ { "code": "2810764", "type": "LOCAL" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"}]}]},{"description":"8 Foot Disposable Extension Cable with","code_information":[ { "code": "270000003", "type": "LOCAL" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"}]}]},{"description":"8 mm Bladeless Obturator","code_information":[ { "code": "3021122", "type": "LOCAL" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"}]}]},{"description":"8 mm Bladeless Obturator, Long","code_information":[ { "code": "3021123", "type": "LOCAL" } ],"standard_charges":[{"minimum":44.1000,"maximum":44.1000,"gross_charge":44.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":44.1000,"methodology":"fee schedule"}]}]},{"description":"8 mm Instrument Cannula","code_information":[ { "code": "3021124", "type": "LOCAL" } ],"standard_charges":[{"minimum":882.0000,"maximum":882.0000,"gross_charge":882.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.0000,"methodology":"fee schedule"}]}]},{"description":"8 mm Instrument Cannula, Long","code_information":[ { "code": "3021125", "type": "LOCAL" } ],"standard_charges":[{"minimum":956.2000,"maximum":956.2000,"gross_charge":956.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":956.2000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021085", "type": "LOCAL" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent Graft System","code_information":[ { "code": "3021086", "type": "LOCAL" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021074", "type": "LOCAL" } ],"standard_charges":[{"minimum":10500.0000,"maximum":10500.0000,"gross_charge":10500.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10500.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021076", "type": "LOCAL" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Abdominal Stent-Graft System","code_information":[ { "code": "3021339", "type": "LOCAL" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Accolade MRI DR L311","code_information":[ { "code": "2820784", "type": "LOCAL" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Accolade MRI SR L310","code_information":[ { "code": "3017204", "type": "LOCAL" } ],"standard_charges":[{"minimum":1881.6000,"maximum":1881.6000,"gross_charge":1881.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1881.6000,"methodology":"fee schedule"}]}]},{"description":"Acetaminophen Injection 1000mg\/100ml","code_information":[ { "code": "250002237", "type": "LOCAL" } ],"standard_charges":[{"minimum":19.4500,"maximum":19.4500,"gross_charge":19.4500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.4500,"methodology":"fee schedule"}]}]},{"description":"Acuity Mailman Straigth Tip Veus","code_information":[ { "code": "270000005", "type": "LOCAL" } ],"standard_charges":[{"minimum":60.2000,"maximum":60.2000,"gross_charge":60.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.2000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Amplatz(A6)","code_information":[ { "code": "270000101", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000103", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Extended","code_information":[ { "code": "270000105", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000107", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Inner","code_information":[ { "code": "270000109", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Multipurpose","code_information":[ { "code": "270000111", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Pro Coronary Sinus Wide(W)","code_information":[ { "code": "270000113", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Spiral 4592 90CM","code_information":[ { "code": "2820792", "type": "LOCAL" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Universal Cutter (Model 7060)","code_information":[ { "code": "270000115", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View DS CS-J Guide Wire","code_information":[ { "code": "270000117", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View DS Straight Tip","code_information":[ { "code": "270000119", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View EDS CS-J Guide","code_information":[ { "code": "270000007", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity Whisper View ES Straight Tip","code_information":[ { "code": "270000121", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Acuity X4 Straight 4671 86CM","code_information":[ { "code": "3017469", "type": "LOCAL" } ],"standard_charges":[{"minimum":1478.4000,"maximum":1478.4000,"gross_charge":1478.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1478.4000,"methodology":"fee schedule"}]}]},{"description":"Acusnare Polypectomy Snare 3 cm x 6 cm","code_information":[ { "code": "270001119", "type": "LOCAL" } ],"standard_charges":[{"minimum":448.0000,"maximum":448.0000,"gross_charge":448.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":448.0000,"methodology":"fee schedule"}]}]},{"description":"Acute Dual Lumen Catheter Kit 4.5mm x","code_information":[ { "code": "270000123", "type": "LOCAL" } ],"standard_charges":[{"minimum":455.0000,"maximum":455.0000,"gross_charge":455.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":455.0000,"methodology":"fee schedule"}]}]},{"description":"Adapta ADDR03","code_information":[ { "code": "2740034", "type": "LOCAL" } ],"standard_charges":[{"minimum":4543.0000,"maximum":4543.0000,"gross_charge":4543.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4543.0000,"methodology":"fee schedule"}]}]},{"description":"Adjustable Slitter 6232ADJ","code_information":[ { "code": "270000009", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Adult Filter","code_information":[ { "code": "2720168", "type": "LOCAL" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"}]}]},{"description":"Adult Head Positioner Pillow","code_information":[ { "code": "270000125", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.0700,"maximum":11.0700,"gross_charge":11.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.0700,"methodology":"fee schedule"}]}]},{"description":"Adult Hemo Concentrator","code_information":[ { "code": "3020683", "type": "LOCAL" } ],"standard_charges":[{"minimum":145.8400,"maximum":145.8400,"gross_charge":145.8400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":145.8400,"methodology":"fee schedule"}]}]},{"description":"Adult Regional Saturation Sensor","code_information":[ { "code": "270000127", "type": "LOCAL" } ],"standard_charges":[{"minimum":27.6900,"maximum":27.6900,"gross_charge":27.6900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.6900,"methodology":"fee schedule"}]}]},{"description":"Adults Shroud Kit","code_information":[ { "code": "2710465", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.0000,"maximum":5.0000,"gross_charge":5.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.0000,"methodology":"fee schedule"}]}]},{"description":"After Hour Panel - Fee for weekends and holidays","code_information":[ { "code": "99051", "type": "LOCAL" } ],"standard_charges":[{"minimum":100.0000,"maximum":100.0000,"gross_charge":100.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":100.0000,"methodology":"fee schedule"}]}]},{"description":"Ag Screening spec order 1-10","code_information":[ { "code": "G0103", "type": "LOCAL" } ],"standard_charges":[{"minimum":59.0000,"maximum":59.0000,"gross_charge":59.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":59.0000,"methodology":"fee schedule"}]}]},{"description":"Ag Screening spec order 11-20","code_information":[ { "code": "G0102", "type": "LOCAL" } ],"standard_charges":[{"minimum":116.5000,"maximum":116.5000,"gross_charge":116.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.5000,"methodology":"fee schedule"}]}]},{"description":"Ag type per donor Red Blood Cells (RBC) per anligen","code_information":[ { "code": "86904", "type": "LOCAL" } ],"standard_charges":[{"minimum":92.5000,"maximum":92.5000,"gross_charge":92.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.5000,"methodology":"fee schedule"}]}]},{"description":"AICD Lead Stylet (Model 6828)","code_information":[ { "code": "270000129", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"AICD Lead Stylets (Model 6972)","code_information":[ { "code": "270000131", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Airway 10 MM Oral Disp Infant","code_information":[ { "code": "2709015", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.2000,"maximum":4.2000,"gross_charge":4.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.2000,"methodology":"fee schedule"}]}]},{"description":"Airway 100 MM (Oral Disposable)","code_information":[ { "code": "2709020", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.2000,"maximum":11.2000,"gross_charge":11.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.2000,"methodology":"fee schedule"}]}]},{"description":"Airway 40 MM Oral Infant","code_information":[ { "code": "2706563", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2500,"maximum":0.2500,"gross_charge":0.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2500,"methodology":"fee schedule"}]}]},{"description":"Albuterol Sulfate Inhalation Aerosol","code_information":[ { "code": "250000075", "type": "LOCAL" } ],"standard_charges":[{"minimum":266.1000,"maximum":266.1000,"gross_charge":266.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.1000,"methodology":"fee schedule"}]}]},{"description":"Alcohol Prep","code_information":[ { "code": "2706000", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0100,"maximum":0.0100,"gross_charge":0.0100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0100,"methodology":"fee schedule"}]}]},{"description":"Alcohol Swabticks","code_information":[ { "code": "2701285", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0700,"maximum":0.0700,"gross_charge":0.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"}]}]},{"description":"Alexis Wound Protector\/Retractor XS","code_information":[ { "code": "2790934", "type": "LOCAL" } ],"standard_charges":[{"minimum":75.6000,"maximum":75.6000,"gross_charge":75.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.6000,"methodology":"fee schedule"}]}]},{"description":"Allevyn plus Adhesive 9 X 9","code_information":[ { "code": "2770400", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.5800,"maximum":11.5800,"gross_charge":11.5800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.5800,"methodology":"fee schedule"}]}]},{"description":"Allure CRT-P Quadripolar","code_information":[ { "code": "8017738", "type": "LOCAL" } ],"standard_charges":[{"minimum":2612.4000,"maximum":2612.4000,"gross_charge":2612.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2612.4000,"methodology":"fee schedule"}]}]},{"description":"Aluminum Stylette- Pediatric Size 11''","code_information":[ { "code": "2709190", "type": "LOCAL" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Ambu Adult\/Pediatric","code_information":[ { "code": "2700659", "type": "LOCAL" } ],"standard_charges":[{"minimum":15.4000,"maximum":15.4000,"gross_charge":15.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.4000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Piccolo Occluder Duct","code_information":[ { "code": "3019766", "type": "LOCAL" } ],"standard_charges":[{"minimum":11900.0000,"maximum":11900.0000,"gross_charge":11900.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11900.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3010991", "type": "LOCAL" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Amulet Left Atrial Appendage","code_information":[ { "code": "3011012", "type": "LOCAL" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Duct Occluder 12mm\/10mm\/8mm","code_information":[ { "code": "2780732", "type": "LOCAL" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Guidewire 260cm\/1.5mm Abbott","code_information":[ { "code": "2780726", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Multifenestrated Septal","code_information":[ { "code": "2780736", "type": "LOCAL" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Muscular VSD Occluder","code_information":[ { "code": "2780735", "type": "LOCAL" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer PFO Occluder 18mm Abbott","code_information":[ { "code": "3017640", "type": "LOCAL" } ],"standard_charges":[{"minimum":7560.0000,"maximum":7560.0000,"gross_charge":7560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7560.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Septal Occluder 10mm Abbott","code_information":[ { "code": "2780729", "type": "LOCAL" } ],"standard_charges":[{"minimum":6650.0000,"maximum":6650.0000,"gross_charge":6650.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6650.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 18mm\/70cm","code_information":[ { "code": "270000135", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 24mm\/70cm","code_information":[ { "code": "270000137", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Sizing Balloon II 34mm\/70cm","code_information":[ { "code": "270000139", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman 45 Delivery System","code_information":[ { "code": "270000141", "type": "LOCAL" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman Delivery Sheath 9F","code_information":[ { "code": "270000143", "type": "LOCAL" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Talisman PFO Occluder","code_information":[ { "code": "3020851", "type": "LOCAL" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000145", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 180 Delivery System","code_information":[ { "code": "270000147", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45 Delivery System","code_information":[ { "code": "270000149", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45x45 14F\/80cm","code_information":[ { "code": "270000151", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue 45x45 Delivery","code_information":[ { "code": "270000153", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000155", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000157", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer TorqVue LP Delivery System","code_information":[ { "code": "270000159", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000161", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000163", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000165", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000167", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000169", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Amplatzer Trevisio 45 Intravascular","code_information":[ { "code": "270000171", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Anectine (Succinylcholine Chloride)","code_information":[ { "code": "250002015", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7200,"maximum":2.7200,"gross_charge":2.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7200,"methodology":"fee schedule"}]}]},{"description":"Angio Cath 16 g x 2 1\/4","code_information":[ { "code": "2708616", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1900,"maximum":1.1900,"gross_charge":1.1900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"}]}]},{"description":"Angio Cath 22 G x 1","code_information":[ { "code": "2720273", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1900,"maximum":1.1900,"gross_charge":1.1900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"}]}]},{"description":"Angio Catheter 22G 1'' Optiva IV","code_information":[ { "code": "270000173", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.8800,"maximum":1.8800,"gross_charge":1.8800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8800,"methodology":"fee schedule"}]}]},{"description":"Angio Catheter 24G 3\/4'' Optiva IV","code_information":[ { "code": "270000175", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.7300,"maximum":1.7300,"gross_charge":1.7300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7300,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 4F\/100cm\/.38\"","code_information":[ { "code": "270000177", "type": "LOCAL" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 4F\/65cm\/.035\"","code_information":[ { "code": "270000179", "type": "LOCAL" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 5F\/100cm\/.38\"","code_information":[ { "code": "270000181", "type": "LOCAL" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter 5F\/65cm\/PIGTAIL","code_information":[ { "code": "270000183", "type": "LOCAL" } ],"standard_charges":[{"minimum":532.0000,"maximum":532.0000,"gross_charge":532.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":532.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter Extension 100cm","code_information":[ { "code": "270000185", "type": "LOCAL" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter Extension 65cm","code_information":[ { "code": "270000187", "type": "LOCAL" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheter UF 5F\/65cm\/.035\"","code_information":[ { "code": "270000189", "type": "LOCAL" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"}]}]},{"description":"Angiographic Catheters","code_information":[ { "code": "270000191", "type": "LOCAL" } ],"standard_charges":[{"minimum":127.4000,"maximum":127.4000,"gross_charge":127.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":127.4000,"methodology":"fee schedule"}]}]},{"description":"Angio-Seal Vascular Closure Device 6F","code_information":[ { "code": "2780198", "type": "LOCAL" } ],"standard_charges":[{"minimum":245.0000,"maximum":245.0000,"gross_charge":245.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":245.0000,"methodology":"fee schedule"}]}]},{"description":"Angio-Touch Kit AT X65","code_information":[ { "code": "270000193", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Antimicrobial and adherent Island","code_information":[ { "code": "2705449", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Antimicrobial and adherent Island","code_information":[ { "code": "270000195", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.7500,"maximum":1.7500,"gross_charge":1.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7500,"methodology":"fee schedule"}]}]},{"description":"Aorta Punch 2.8mm","code_information":[ { "code": "270001121", "type": "LOCAL" } ],"standard_charges":[{"minimum":29.6000,"maximum":29.6000,"gross_charge":29.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.6000,"methodology":"fee schedule"}]}]},{"description":"Aorta Punch 4.0","code_information":[ { "code": "270001123", "type": "LOCAL" } ],"standard_charges":[{"minimum":52.2800,"maximum":52.2800,"gross_charge":52.2800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2800,"methodology":"fee schedule"}]}]},{"description":"Aortic Balloon 10Fr x 120 cm x 0.038\"","code_information":[ { "code": "2704965", "type": "LOCAL" } ],"standard_charges":[{"minimum":90.0000,"maximum":90.0000,"gross_charge":90.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":90.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Cannula Pediatric","code_information":[ { "code": "2702290", "type": "LOCAL" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Canula Adult","code_information":[ { "code": "2702320", "type": "LOCAL" } ],"standard_charges":[{"minimum":51.1000,"maximum":51.1000,"gross_charge":51.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.1000,"methodology":"fee schedule"}]}]},{"description":"Aortic FlexCuff Rotatable Mechanical","code_information":[ { "code": "2703875", "type": "LOCAL" } ],"standard_charges":[{"minimum":5726.0000,"maximum":5726.0000,"gross_charge":5726.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5726.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Regent Flex W\/O Silicone Model:","code_information":[ { "code": "2790177", "type": "LOCAL" } ],"standard_charges":[{"minimum":5425.0000,"maximum":5425.0000,"gross_charge":5425.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5425.0000,"methodology":"fee schedule"}]}]},{"description":"Aortic Root Cannula 12 GA.","code_information":[ { "code": "2702335", "type": "LOCAL" } ],"standard_charges":[{"minimum":29.7500,"maximum":29.7500,"gross_charge":29.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"}]}]},{"description":"Aorto Punch 4.5","code_information":[ { "code": "270001125", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"}]}]},{"description":"Aorto Punch 4.8","code_information":[ { "code": "2700051", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"Apheresis Imported from US","code_information":[ { "code": "EU102", "type": "LOCAL" } ],"standard_charges":[{"minimum":750.0000,"maximum":750.0000,"gross_charge":750.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":750.0000,"methodology":"fee schedule"}]}]},{"description":"Appose ULC Slim Body Skin Stapler 35","code_information":[ { "code": "3021163", "type": "LOCAL" } ],"standard_charges":[{"minimum":504.0000,"maximum":504.0000,"gross_charge":504.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.0000,"methodology":"fee schedule"}]}]},{"description":"Argyle Latex Penrose Tubbing 38 mm x","code_information":[ { "code": "270001127", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Arterial Aortic Cannula 22 Fr","code_information":[ { "code": "2702315", "type": "LOCAL" } ],"standard_charges":[{"minimum":21.0000,"maximum":21.0000,"gross_charge":21.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0000,"methodology":"fee schedule"}]}]},{"description":"Arterial Canula Support (Femoral)","code_information":[ { "code": "2702955", "type": "LOCAL" } ],"standard_charges":[{"minimum":17.6400,"maximum":17.6400,"gross_charge":17.6400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.6400,"methodology":"fee schedule"}]}]},{"description":"Arterial Hand Aid Adult (08154)","code_information":[ { "code": "2702960", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.1000,"maximum":2.1000,"gross_charge":2.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"}]}]},{"description":"Assurity MRI DR Pulse Generator PM2272","code_information":[ { "code": "2820766", "type": "LOCAL" } ],"standard_charges":[{"minimum":3129.0000,"maximum":3129.0000,"gross_charge":3129.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3129.0000,"methodology":"fee schedule"}]}]},{"description":"Ativan (Lorazepam Injection, USP)","code_information":[ { "code": "250001305", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.6600,"maximum":2.6600,"gross_charge":2.6600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6600,"methodology":"fee schedule"}]}]},{"description":"AtriCure cryoICE\/Cryoablation Probe 10","code_information":[ { "code": "3020712", "type": "LOCAL" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure cryoICE\/cryoSPHERE 18''","code_information":[ { "code": "270000201", "type": "LOCAL" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"}]}]},{"description":"AtriCure Isolator SYNERGY","code_information":[ { "code": "3020711", "type": "LOCAL" } ],"standard_charges":[{"minimum":2205.0000,"maximum":2205.0000,"gross_charge":2205.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2205.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V #45","code_information":[ { "code": "3021066", "type": "LOCAL" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 50","code_information":[ { "code": "3021067", "type": "LOCAL" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 35","code_information":[ { "code": "3020713", "type": "LOCAL" } ],"standard_charges":[{"minimum":1573.6000,"maximum":1573.6000,"gross_charge":1573.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1573.6000,"methodology":"fee schedule"}]}]},{"description":"AtriCure\/AtriClip FLEX V 40","code_information":[ { "code": "3021065", "type": "LOCAL" } ],"standard_charges":[{"minimum":1890.0000,"maximum":1890.0000,"gross_charge":1890.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1890.0000,"methodology":"fee schedule"}]}]},{"description":"Atrion QL 2530 Disposable Inflation","code_information":[ { "code": "270000205", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Atrion QL38 Locking Syringe Device","code_information":[ { "code": "270000207", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Ability MRI SureScan 4196-78","code_information":[ { "code": "2720393", "type": "LOCAL" } ],"standard_charges":[{"minimum":756.0000,"maximum":756.0000,"gross_charge":756.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":756.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MB2","code_information":[ { "code": "270000011", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MP","code_information":[ { "code": "270000013", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command + SureValve 6250V-MPR","code_information":[ { "code": "270000015", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Command+ SureValve 6250V-EH","code_information":[ { "code": "270000017", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"ATTAIN HYBRID Guide Wire GWR419688","code_information":[ { "code": "270000019", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa MRI SureScan 4298- 88","code_information":[ { "code": "2701548", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa MRI SureScan 4298-78","code_information":[ { "code": "2820686", "type": "LOCAL" } ],"standard_charges":[{"minimum":1960.0000,"maximum":1960.0000,"gross_charge":1960.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1960.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Performa Straight MRI SureScan","code_information":[ { "code": "2720944", "type": "LOCAL" } ],"standard_charges":[{"minimum":700.0000,"maximum":700.0000,"gross_charge":700.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":700.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Select II + Sure Valve","code_information":[ { "code": "270000021", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Select II + SureValve","code_information":[ { "code": "270000023", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Attain Stability Quad MRI SureScan","code_information":[ { "code": "3021029", "type": "LOCAL" } ],"standard_charges":[{"minimum":973.0000,"maximum":973.0000,"gross_charge":973.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":973.0000,"methodology":"fee schedule"}]}]},{"description":"Attesta DR MRI SureScan ATDR01","code_information":[ { "code": "3020146", "type": "LOCAL" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"Auto Suture Circular Stapler with DST","code_information":[ { "code": "2760737", "type": "LOCAL" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"}]}]},{"description":"Auto Transfusion Complete Kit (Wash","code_information":[ { "code": "3021054", "type": "LOCAL" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 10F\/11cm","code_information":[ { "code": "270000209", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 4F\/11cm","code_information":[ { "code": "270000211", "type": "LOCAL" } ],"standard_charges":[{"minimum":27.1900,"maximum":27.1900,"gross_charge":27.1900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.1900,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 5F\/11cm","code_information":[ { "code": "270000213", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 6Fr\/11cm","code_information":[ { "code": "270000215", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Avanti Introducer 7F\/11cm","code_information":[ { "code": "270000217", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021249", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021250", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "3021251", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001361", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001363", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001365", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 18 Peripheral Coil System","code_information":[ { "code": "270001371", "type": "LOCAL" } ],"standard_charges":[{"minimum":1296.4000,"maximum":1296.4000,"gross_charge":1296.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1296.4000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001359", "type": "LOCAL" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001367", "type": "LOCAL" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR CX 35 Peripheral Coil System","code_information":[ { "code": "270001369", "type": "LOCAL" } ],"standard_charges":[{"minimum":1862.0000,"maximum":1862.0000,"gross_charge":1862.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1862.0000,"methodology":"fee schedule"}]}]},{"description":"AZUR Detachment Controller","code_information":[ { "code": "3021248", "type": "LOCAL" } ],"standard_charges":[{"minimum":186.0000,"maximum":186.0000,"gross_charge":186.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":186.0000,"methodology":"fee schedule"}]}]},{"description":"Azure XT DR MRI SureScan W1DR01","code_information":[ { "code": "3019421", "type": "LOCAL" } ],"standard_charges":[{"minimum":2520.0000,"maximum":2520.0000,"gross_charge":2520.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2520.0000,"methodology":"fee schedule"}]}]},{"description":"Azure XT SR MRI SureScan W1SR01","code_information":[ { "code": "3019301", "type": "LOCAL" } ],"standard_charges":[{"minimum":2310.0000,"maximum":2310.0000,"gross_charge":2310.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2310.0000,"methodology":"fee schedule"}]}]},{"description":"Baby Rx Oxygenators Neonatal","code_information":[ { "code": "2780945", "type": "LOCAL" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"}]}]},{"description":"Bair Hugger","code_information":[ { "code": "2700097", "type": "LOCAL" } ],"standard_charges":[{"minimum":175.0000,"maximum":175.0000,"gross_charge":175.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":175.0000,"methodology":"fee schedule"}]}]},{"description":"Balloon Catheter Model 6714 6F 90cm","code_information":[ { "code": "270000219", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Band 638bl #26 CG Future Anulo 29L","code_information":[ { "code": "2800636", "type": "LOCAL" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"Band-Aids","code_information":[ { "code": "2705736", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.1700,"maximum":2.1700,"gross_charge":2.1700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1700,"methodology":"fee schedule"}]}]},{"description":"BD Chloraprep Hi-Lite Orange 26 ml","code_information":[ { "code": "270000221", "type": "LOCAL" } ],"standard_charges":[{"minimum":14.7200,"maximum":14.7200,"gross_charge":14.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7200,"methodology":"fee schedule"}]}]},{"description":"BD ChloraPrep Hi-Lite Orange 3 mL","code_information":[ { "code": "2750001", "type": "LOCAL" } ],"standard_charges":[{"minimum":15.9600,"maximum":15.9600,"gross_charge":15.9600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.9600,"methodology":"fee schedule"}]}]},{"description":"BD Eclipse 1 mL 27 G x 1\/2 Tuberculin","code_information":[ { "code": "270000225", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.6800,"maximum":0.6800,"gross_charge":0.6800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"}]}]},{"description":"BD Eclipse 3 mL 21 G x 11\/2 TW","code_information":[ { "code": "270000227", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.4000,"maximum":0.4000,"gross_charge":0.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4000,"methodology":"fee schedule"}]}]},{"description":"BD Eclipse Needle 22 g X 11 \/2","code_information":[ { "code": "270000229", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7400,"maximum":2.7400,"gross_charge":2.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7400,"methodology":"fee schedule"}]}]},{"description":"BD Eclipse Syringe 5mL 23 G x 11\/2''","code_information":[ { "code": "270000231", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.2100,"maximum":1.2100,"gross_charge":1.2100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2100,"methodology":"fee schedule"}]}]},{"description":"BD E-Z Scrub 160 Surgical Brush\/Sponge","code_information":[ { "code": "270000223", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1300,"maximum":1.1300,"gross_charge":1.1300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"}]}]},{"description":"BD Insyte Autoguard Angio 18 GA x","code_information":[ { "code": "270000233", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7600,"maximum":2.7600,"gross_charge":2.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"}]}]},{"description":"BD Insyte Autoguard Angio 20 GA x 1.00","code_information":[ { "code": "270000235", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7600,"maximum":2.7600,"gross_charge":2.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"}]}]},{"description":"BD Insyte Autoguard Angio 22 GA x 1.00","code_information":[ { "code": "270000237", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7600,"maximum":2.7600,"gross_charge":2.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"}]}]},{"description":"BD Insyte Autoguard Angio 24 GA x 0.75","code_information":[ { "code": "270000239", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7600,"maximum":2.7600,"gross_charge":2.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"}]}]},{"description":"BD Luer-Lock 10ml Syringe Steril Ref:","code_information":[ { "code": "270000241", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.1800,"maximum":0.1800,"gross_charge":0.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"}]}]},{"description":"BD Precision Glide Needle 23G x 1''","code_information":[ { "code": "270000243", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0600,"maximum":0.0600,"gross_charge":0.0600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"}]}]},{"description":"BD Precision Glide Needle 25G x 1","code_information":[ { "code": "270000245", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0600,"maximum":0.0600,"gross_charge":0.0600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"}]}]},{"description":"BD Precision Glide Needle 25G x 1''","code_information":[ { "code": "270000247", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0600,"maximum":0.0600,"gross_charge":0.0600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0600,"methodology":"fee schedule"}]}]},{"description":"BD Precision Glide Needle 27G x 1","code_information":[ { "code": "270000249", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.6800,"maximum":0.6800,"gross_charge":0.6800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6800,"methodology":"fee schedule"}]}]},{"description":"BD Safety Glide Needle 18G x 1 1\/2","code_information":[ { "code": "270000251", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.7600,"maximum":2.7600,"gross_charge":2.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.7600,"methodology":"fee schedule"}]}]},{"description":"BD SafetyGlide Insulin Syringe 1mL x31","code_information":[ { "code": "270000253", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.4800,"maximum":0.4800,"gross_charge":0.4800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4800,"methodology":"fee schedule"}]}]},{"description":"BD Syringe 10ml","code_information":[ { "code": "270000255", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.1800,"maximum":0.1800,"gross_charge":0.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1800,"methodology":"fee schedule"}]}]},{"description":"BD Syringe 20 ml","code_information":[ { "code": "270000257", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.3900,"maximum":0.3900,"gross_charge":0.3900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"}]}]},{"description":"BD Syringe 50 ml","code_information":[ { "code": "270000259", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.3900,"maximum":0.3900,"gross_charge":0.3900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3900,"methodology":"fee schedule"}]}]},{"description":"BD Vacuntainer Holder","code_information":[ { "code": "270000261", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.9400,"maximum":2.9400,"gross_charge":2.9400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"}]}]},{"description":"BD Vacutainer Safety-Lok Butterfly","code_information":[ { "code": "270000263", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.3700,"maximum":1.3700,"gross_charge":1.3700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"}]}]},{"description":"Beaver Blade #11","code_information":[ { "code": "2705393", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Betadine Solution 16oz","code_information":[ { "code": "2700780", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.3200,"maximum":0.3200,"gross_charge":0.3200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3200,"methodology":"fee schedule"}]}]},{"description":"Betadine's\\Swabs-Tick","code_information":[ { "code": "2701280", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.5000,"maximum":2.5000,"gross_charge":2.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5000,"methodology":"fee schedule"}]}]},{"description":"Betasept","code_information":[ { "code": "2710789", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.8100,"maximum":8.8100,"gross_charge":8.8100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.8100,"methodology":"fee schedule"}]}]},{"description":"BI-Cava Fem Cannula 24\/29","code_information":[ { "code": "2760250", "type": "LOCAL" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"}]}]},{"description":"Bio pump Perfusion Service (Biomedics","code_information":[ { "code": "2740010", "type": "LOCAL" } ],"standard_charges":[{"minimum":299.0000,"maximum":299.0000,"gross_charge":299.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":299.0000,"methodology":"fee schedule"}]}]},{"description":"Biogel Surgeons Glove 7","code_information":[ { "code": "270000267", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.9600,"maximum":2.9600,"gross_charge":2.9600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9600,"methodology":"fee schedule"}]}]},{"description":"Biogel Surgeons Gloves 7 1\/2","code_information":[ { "code": "2709667", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.6000,"maximum":4.6000,"gross_charge":4.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.6000,"methodology":"fee schedule"}]}]},{"description":"Biogel Surgeons Gloves 8","code_information":[ { "code": "270000271", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0200,"maximum":3.0200,"gross_charge":3.0200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0200,"methodology":"fee schedule"}]}]},{"description":"BioGlue Syringe Surgical Adhesive 5 ml","code_information":[ { "code": "270001129", "type": "LOCAL" } ],"standard_charges":[{"minimum":653.8000,"maximum":653.8000,"gross_charge":653.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":653.8000,"methodology":"fee schedule"}]}]},{"description":"Bio-Medicus Percutaneus Kit 25F","code_information":[ { "code": "270000265", "type": "LOCAL" } ],"standard_charges":[{"minimum":1008.0000,"maximum":1008.0000,"gross_charge":1008.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1008.0000,"methodology":"fee schedule"}]}]},{"description":"Biopsy Valve MAJ 210","code_information":[ { "code": "3008851", "type": "LOCAL" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"}]}]},{"description":"Biotronix Gauze Sponges 4'' x 4''","code_information":[ { "code": "270000273", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0400,"maximum":0.0400,"gross_charge":0.0400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"}]}]},{"description":"Biotronix Sponges Gauze 4'' x 4'' (X","code_information":[ { "code": "270000275", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0400,"maximum":0.0400,"gross_charge":0.0400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"}]}]},{"description":"Bipolar Pacing 5 Fr","code_information":[ { "code": "2710634", "type": "LOCAL" } ],"standard_charges":[{"minimum":91.0000,"maximum":91.0000,"gross_charge":91.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Bipolar Temporary Pacing","code_information":[ { "code": "2770176", "type": "LOCAL" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Bladeless Trocars with Stability","code_information":[ { "code": "270000277", "type": "LOCAL" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Blake Drain # 15","code_information":[ { "code": "270001131", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blake Drain # 19","code_information":[ { "code": "270001133", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blake Drains # 10","code_information":[ { "code": "270001135", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.7700,"maximum":30.7700,"gross_charge":30.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.7700,"methodology":"fee schedule"}]}]},{"description":"Blood (whole) for transfusion, per unit","code_information":[ { "code": "P9010", "type": "LOCAL" } ],"standard_charges":[{"minimum":180.0000,"maximum":180.0000,"gross_charge":180.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":180.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Basic Set 1 Injection Site","code_information":[ { "code": "2709285", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Blood Pressure Cuff Adult 11 (M)","code_information":[ { "code": "270000279", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.5100,"maximum":4.5100,"gross_charge":4.5100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"}]}]},{"description":"Blood Pressure Cuff Adult 12 (L)","code_information":[ { "code": "270000281", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.5100,"maximum":4.5100,"gross_charge":4.5100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.5100,"methodology":"fee schedule"}]}]},{"description":"Blood Pressure Cuff Small Adult 10","code_information":[ { "code": "270000283", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.3400,"maximum":4.3400,"gross_charge":4.3400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3400,"methodology":"fee schedule"}]}]},{"description":"Blood split unit","code_information":[ { "code": "P9011", "type": "LOCAL" } ],"standard_charges":[{"minimum":225.0000,"maximum":225.0000,"gross_charge":225.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":225.0000,"methodology":"fee schedule"}]}]},{"description":"Blue Pads","code_information":[ { "code": "2705438", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Bone Wax","code_information":[ { "code": "270001137", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.4700,"maximum":5.4700,"gross_charge":5.4700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.4700,"methodology":"fee schedule"}]}]},{"description":"Bowl (SP Multipurpose Container)","code_information":[ { "code": "2705406", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.1400,"maximum":35.1400,"gross_charge":35.1400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.1400,"methodology":"fee schedule"}]}]},{"description":"Bowl (specimen) S M L","code_information":[ { "code": "2706685", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2000,"maximum":0.2000,"gross_charge":0.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2000,"methodology":"fee schedule"}]}]},{"description":"Breathing Circuit Adult","code_information":[ { "code": "2700802", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.7500,"maximum":8.7500,"gross_charge":8.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.7500,"methodology":"fee schedule"}]}]},{"description":"Breathing Circuit Pediatric","code_information":[ { "code": "2705319", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.9300,"maximum":7.9300,"gross_charge":7.9300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.9300,"methodology":"fee schedule"}]}]},{"description":"BritePro Omni All-in-One laryngoscoppe","code_information":[ { "code": "3020540", "type": "LOCAL" } ],"standard_charges":[{"minimum":15.7500,"maximum":15.7500,"gross_charge":15.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"}]}]},{"description":"Bronchoscope Cytology Brush G22178","code_information":[ { "code": "270001139", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Bronchoscope Double Swivel","code_information":[ { "code": "2711195", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0500,"maximum":3.0500,"gross_charge":3.0500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"}]}]},{"description":"Bulb Syringe Irrigation with","code_information":[ { "code": "270000287", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.4800,"maximum":1.4800,"gross_charge":1.4800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4800,"methodology":"fee schedule"}]}]},{"description":"Bundle Laparotomy Pack","code_information":[ { "code": "270000289", "type": "LOCAL" } ],"standard_charges":[{"minimum":16.6200,"maximum":16.6200,"gross_charge":16.6200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.6200,"methodology":"fee schedule"}]}]},{"description":"C- ARM Convertors Banded Bag 30'' (76","code_information":[ { "code": "270000291", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.6200,"maximum":8.6200,"gross_charge":8.6200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6200,"methodology":"fee schedule"}]}]},{"description":"C V Pediatric Pack (Bundle)","code_information":[ { "code": "270001141", "type": "LOCAL" } ],"standard_charges":[{"minimum":173.2500,"maximum":173.2500,"gross_charge":173.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":173.2500,"methodology":"fee schedule"}]}]},{"description":"C.PR0THORACOTOMY LUNG INFILTRA","code_information":[ { "code": "975000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":393.3700,"maximum":393.3700,"gross_charge":393.3700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.3700,"methodology":"fee schedule"}]}]},{"description":"C.PROASCE AOR GRAF CPB (ANEUR)","code_information":[ { "code": "975000059", "type": "LOCAL" } ],"standard_charges":[{"minimum":2340.6300,"maximum":2340.6300,"gross_charge":2340.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2340.6300,"methodology":"fee schedule"}]}]},{"description":"C.PROBRONCHOSCOPYNAVIGATIONAL","code_information":[ { "code": "975000169", "type": "LOCAL" } ],"standard_charges":[{"minimum":1065.6500,"maximum":1065.6500,"gross_charge":1065.6500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1065.6500,"methodology":"fee schedule"}]}]},{"description":"C.PROCORON ART BYPFOUR VENO GR","code_information":[ { "code": "975000051", "type": "LOCAL" } ],"standard_charges":[{"minimum":1316.2500,"maximum":1316.2500,"gross_charge":1316.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1316.2500,"methodology":"fee schedule"}]}]},{"description":"C.PROCORON ART BYPTHREE VEN GR","code_information":[ { "code": "975000049", "type": "LOCAL" } ],"standard_charges":[{"minimum":987.6800,"maximum":987.6800,"gross_charge":987.6800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":987.6800,"methodology":"fee schedule"}]}]},{"description":"C.PROFAORTOPLASTY","code_information":[ { "code": "975000023", "type": "LOCAL" } ],"standard_charges":[{"minimum":1490.0000,"maximum":1490.0000,"gross_charge":1490.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1490.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFASCE AOR GRAFT CPB DISS","code_information":[ { "code": "975000057", "type": "LOCAL" } ],"standard_charges":[{"minimum":2489.1700,"maximum":2489.1700,"gross_charge":2489.1700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2489.1700,"methodology":"fee schedule"}]}]},{"description":"C.PROFASCEN AOR GRA ROOT REPL","code_information":[ { "code": "975000061", "type": "LOCAL" } ],"standard_charges":[{"minimum":1984.5100,"maximum":1984.5100,"gross_charge":1984.5100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1984.5100,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOBRONCHIALVEOLA","code_information":[ { "code": "975000165", "type": "LOCAL" } ],"standard_charges":[{"minimum":255.2800,"maximum":255.2800,"gross_charge":255.2800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":255.2800,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCODILATIONCLOSED","code_information":[ { "code": "975000175", "type": "LOCAL" } ],"standard_charges":[{"minimum":193.8200,"maximum":193.8200,"gross_charge":193.8200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":193.8200,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCONEEDLEASPIRATI","code_information":[ { "code": "975000173", "type": "LOCAL" } ],"standard_charges":[{"minimum":452.0200,"maximum":452.0200,"gross_charge":452.0200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":452.0200,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOPBRUSHING","code_information":[ { "code": "975000163", "type": "LOCAL" } ],"standard_charges":[{"minimum":274.4000,"maximum":274.4000,"gross_charge":274.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOPDIAGNOSTICELL","code_information":[ { "code": "975000161", "type": "LOCAL" } ],"standard_charges":[{"minimum":249.8900,"maximum":249.8900,"gross_charge":249.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":249.8900,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOPENDOBRONCHIAL","code_information":[ { "code": "975000167", "type": "LOCAL" } ],"standard_charges":[{"minimum":348.6400,"maximum":348.6400,"gross_charge":348.6400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":348.6400,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOPYWEXCISITUMOR","code_information":[ { "code": "975000179", "type": "LOCAL" } ],"standard_charges":[{"minimum":241.1200,"maximum":241.1200,"gross_charge":241.1200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":241.1200,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOTRACHEALSTENTD","code_information":[ { "code": "975000177", "type": "LOCAL" } ],"standard_charges":[{"minimum":220.7900,"maximum":220.7900,"gross_charge":220.7900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":220.7900,"methodology":"fee schedule"}]}]},{"description":"C.PROFBRONCHOSCOTRANSBRONCHILU","code_information":[ { "code": "975000171", "type": "LOCAL" } ],"standard_charges":[{"minimum":371.3300,"maximum":371.3300,"gross_charge":371.3300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.3300,"methodology":"fee schedule"}]}]},{"description":"C.PROFCABG VEIN TWO","code_information":[ { "code": "975000123", "type": "LOCAL" } ],"standard_charges":[{"minimum":2163.0000,"maximum":2163.0000,"gross_charge":2163.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2163.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFCARINALRECONSTRUCTION","code_information":[ { "code": "975000255", "type": "LOCAL" } ],"standard_charges":[{"minimum":1743.5800,"maximum":1743.5800,"gross_charge":1743.5800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1743.5800,"methodology":"fee schedule"}]}]},{"description":"C.PROFCORON ART BYP TWO VEN GR","code_information":[ { "code": "975000047", "type": "LOCAL" } ],"standard_charges":[{"minimum":658.1300,"maximum":658.1300,"gross_charge":658.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":658.1300,"methodology":"fee schedule"}]}]},{"description":"C.PROFCORONAR ART BYP ART GRA","code_information":[ { "code": "975000043", "type": "LOCAL" } ],"standard_charges":[{"minimum":2237.6300,"maximum":2237.6300,"gross_charge":2237.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2237.6300,"methodology":"fee schedule"}]}]},{"description":"C.PROFCORONARY ART BYP SINGLE","code_information":[ { "code": "975000041", "type": "LOCAL" } ],"standard_charges":[{"minimum":2486.2500,"maximum":2486.2500,"gross_charge":2486.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"}]}]},{"description":"C.PROFCORONARY ART BYP VEN GR","code_information":[ { "code": "975000045", "type": "LOCAL" } ],"standard_charges":[{"minimum":329.5500,"maximum":329.5500,"gross_charge":329.5500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":329.5500,"methodology":"fee schedule"}]}]},{"description":"C.PROFCREATION PERICARDIAL WIN","code_information":[ { "code": "975000011", "type": "LOCAL" } ],"standard_charges":[{"minimum":1126.1300,"maximum":1126.1300,"gross_charge":1126.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"}]}]},{"description":"C.PROFDECORTICATIOPARIETPLEURE","code_information":[ { "code": "975000183", "type": "LOCAL" } ],"standard_charges":[{"minimum":1582.3900,"maximum":1582.3900,"gross_charge":1582.3900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1582.3900,"methodology":"fee schedule"}]}]},{"description":"C.PROFDECORTICATIOPULMONARYPAR","code_information":[ { "code": "975000181", "type": "LOCAL" } ],"standard_charges":[{"minimum":982.2600,"maximum":982.2600,"gross_charge":982.2600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":982.2600,"methodology":"fee schedule"}]}]},{"description":"C.PROFDESCEN THORAC AOR GRAF","code_information":[ { "code": "975000065", "type": "LOCAL" } ],"standard_charges":[{"minimum":1706.4000,"maximum":1706.4000,"gross_charge":1706.4000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1706.4000,"methodology":"fee schedule"}]}]},{"description":"C.PROFDIAPHRAGMATHERNIAREPAIR","code_information":[ { "code": "975000209", "type": "LOCAL" } ],"standard_charges":[{"minimum":927.6600,"maximum":927.6600,"gross_charge":927.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":927.6600,"methodology":"fee schedule"}]}]},{"description":"C.PROFDIAPHRAGMIMBRICATION","code_information":[ { "code": "975000211", "type": "LOCAL" } ],"standard_charges":[{"minimum":887.5800,"maximum":887.5800,"gross_charge":887.5800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":887.5800,"methodology":"fee schedule"}]}]},{"description":"C.PROFDIVERTICULECTOMHYPOPHARY","code_information":[ { "code": "975000237", "type": "LOCAL" } ],"standard_charges":[{"minimum":796.6700,"maximum":796.6700,"gross_charge":796.6700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":796.6700,"methodology":"fee schedule"}]}]},{"description":"C.PROFENDOSCOPYPERCUTANEOGASTR","code_information":[ { "code": "975000225", "type": "LOCAL" } ],"standard_charges":[{"minimum":197.1500,"maximum":197.1500,"gross_charge":197.1500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":197.1500,"methodology":"fee schedule"}]}]},{"description":"C.PROFENDOVASC REP AOR-UNILI","code_information":[ { "code": "975000069", "type": "LOCAL" } ],"standard_charges":[{"minimum":1020.2500,"maximum":1020.2500,"gross_charge":1020.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1020.2500,"methodology":"fee schedule"}]}]},{"description":"C.PROFENDOVASC REP DESCEN AOR","code_information":[ { "code": "975000067", "type": "LOCAL" } ],"standard_charges":[{"minimum":1253.3600,"maximum":1253.3600,"gross_charge":1253.3600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.3600,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGECTOMWCERVICALESO","code_information":[ { "code": "975000141", "type": "LOCAL" } ],"standard_charges":[{"minimum":3733.6900,"maximum":3733.6900,"gross_charge":3733.6900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3733.6900,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGOSCOPROBOTIC","code_information":[ { "code": "975000213", "type": "LOCAL" } ],"standard_charges":[{"minimum":264.3000,"maximum":264.3000,"gross_charge":264.3000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":264.3000,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGOSCOPYDILATIONOVE","code_information":[ { "code": "975000223", "type": "LOCAL" } ],"standard_charges":[{"minimum":386.3400,"maximum":386.3400,"gross_charge":386.3400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":386.3400,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGOSCOPYWBIOPSY","code_information":[ { "code": "975000215", "type": "LOCAL" } ],"standard_charges":[{"minimum":356.7400,"maximum":356.7400,"gross_charge":356.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":356.7400,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGOSCOPYWITHBALLOON","code_information":[ { "code": "975000221", "type": "LOCAL" } ],"standard_charges":[{"minimum":893.9700,"maximum":893.9700,"gross_charge":893.9700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":893.9700,"methodology":"fee schedule"}]}]},{"description":"C.PROFESOPHAGOSCOREMOVALFOREIG","code_information":[ { "code": "975000217", "type": "LOCAL" } ],"standard_charges":[{"minimum":392.9800,"maximum":392.9800,"gross_charge":392.9800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":392.9800,"methodology":"fee schedule"}]}]},{"description":"C.PROFEXCISION INTRACAR TUMOR","code_information":[ { "code": "975000015", "type": "LOCAL" } ],"standard_charges":[{"minimum":1950.0000,"maximum":1950.0000,"gross_charge":1950.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFEXPLORATION POSTOPERATI","code_information":[ { "code": "975000073", "type": "LOCAL" } ],"standard_charges":[{"minimum":562.5000,"maximum":562.5000,"gross_charge":562.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":562.5000,"methodology":"fee schedule"}]}]},{"description":"C.PROFGASTROINTESTINALBALLOOND","code_information":[ { "code": "975000231", "type": "LOCAL" } ],"standard_charges":[{"minimum":1073.0900,"maximum":1073.0900,"gross_charge":1073.0900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1073.0900,"methodology":"fee schedule"}]}]},{"description":"C.PROFGASTROINTESTINALDILATATI","code_information":[ { "code": "975000229", "type": "LOCAL" } ],"standard_charges":[{"minimum":414.0100,"maximum":414.0100,"gross_charge":414.0100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":414.0100,"methodology":"fee schedule"}]}]},{"description":"C.PROFINITIA HOSP CARE EVAL II","code_information":[ { "code": "975000103", "type": "LOCAL" } ],"standard_charges":[{"minimum":144.4800,"maximum":144.4800,"gross_charge":144.4800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":144.4800,"methodology":"fee schedule"}]}]},{"description":"C.PROFINITIAL HOSP CARE EVALU","code_information":[ { "code": "975000101", "type": "LOCAL" } ],"standard_charges":[{"minimum":98.4200,"maximum":98.4200,"gross_charge":98.4200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"}]}]},{"description":"C.PROFINPATIENT CONS CPT99255","code_information":[ { "code": "975000117", "type": "LOCAL" } ],"standard_charges":[{"minimum":75.0000,"maximum":75.0000,"gross_charge":75.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFINPATIENT CONSULTATION","code_information":[ { "code": "975000115", "type": "LOCAL" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFIVORLEWISPARTIALESOPHAGE","code_information":[ { "code": "975000137", "type": "LOCAL" } ],"standard_charges":[{"minimum":3203.7900,"maximum":3203.7900,"gross_charge":3203.7900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3203.7900,"methodology":"fee schedule"}]}]},{"description":"C.PROFLAPAROSCOPESOPHAGLMYOTOR","code_information":[ { "code": "975000239", "type": "LOCAL" } ],"standard_charges":[{"minimum":1276.7800,"maximum":1276.7800,"gross_charge":1276.7800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1276.7800,"methodology":"fee schedule"}]}]},{"description":"C.PROFLAPAROSCOYESOPHAGASTRIFU","code_information":[ { "code": "975000143", "type": "LOCAL" } ],"standard_charges":[{"minimum":1975.3800,"maximum":1975.3800,"gross_charge":1975.3800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1975.3800,"methodology":"fee schedule"}]}]},{"description":"C.PROFMEDIASTINACYSTTRANSTHORA","code_information":[ { "code": "975000207", "type": "LOCAL" } ],"standard_charges":[{"minimum":858.2200,"maximum":858.2200,"gross_charge":858.2200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":858.2200,"methodology":"fee schedule"}]}]},{"description":"C.PROFMEDIASTINOS W\/MEDST BX","code_information":[ { "code": "975000121", "type": "LOCAL" } ],"standard_charges":[{"minimum":313.7200,"maximum":313.7200,"gross_charge":313.7200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":313.7200,"methodology":"fee schedule"}]}]},{"description":"C.PROFMEDIASTINOTOBIOPCERVICAL","code_information":[ { "code": "975000203", "type": "LOCAL" } ],"standard_charges":[{"minimum":504.6600,"maximum":504.6600,"gross_charge":504.6600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":504.6600,"methodology":"fee schedule"}]}]},{"description":"C.PROFMEDIASTINOTOMY TRANSTHO","code_information":[ { "code": "975000075", "type": "LOCAL" } ],"standard_charges":[{"minimum":780.0000,"maximum":780.0000,"gross_charge":780.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":780.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFMEDIASTINOTOMY TRANSTHO","code_information":[ { "code": "975000205", "type": "LOCAL" } ],"standard_charges":[{"minimum":781.0100,"maximum":781.0100,"gross_charge":780.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":781.0100,"methodology":"fee schedule"}]}]},{"description":"C.PROFMINIMAINVESOPHAGECTOMIVO","code_information":[ { "code": "975000139", "type": "LOCAL" } ],"standard_charges":[{"minimum":3495.2900,"maximum":3495.2900,"gross_charge":3495.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3495.2900,"methodology":"fee schedule"}]}]},{"description":"C.PROFMYOCARDIAL RESECTION","code_information":[ { "code": "975000053", "type": "LOCAL" } ],"standard_charges":[{"minimum":2486.2500,"maximum":2486.2500,"gross_charge":2486.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2486.2500,"methodology":"fee schedule"}]}]},{"description":"C.PROFOFFICE CONS(15 MINUTES)","code_information":[ { "code": "975000105", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.0000,"maximum":30.0000,"gross_charge":30.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFOFFICE CONS(30 MINUTES)","code_information":[ { "code": "975000107", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFOFFICE CONS(40 MINUTES)","code_information":[ { "code": "975000109", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.0000,"maximum":40.0000,"gross_charge":40.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFOFFICE CONS(60 MINUTES)","code_information":[ { "code": "975000111", "type": "LOCAL" } ],"standard_charges":[{"minimum":45.0000,"maximum":45.0000,"gross_charge":45.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":45.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFOFFICE CONS(80 MINUTES)","code_information":[ { "code": "975000113", "type": "LOCAL" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFPARAESOPHAGEAHERNIWOMESH","code_information":[ { "code": "975000145", "type": "LOCAL" } ],"standard_charges":[{"minimum":1528.1400,"maximum":1528.1400,"gross_charge":1528.1400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1528.1400,"methodology":"fee schedule"}]}]},{"description":"C.PROFPARAESOPHAGEAHERNWITHMES","code_information":[ { "code": "975000147", "type": "LOCAL" } ],"standard_charges":[{"minimum":1721.0000,"maximum":1721.0000,"gross_charge":1721.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1721.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFPARTIALPULMONADECORTICAT","code_information":[ { "code": "975000195", "type": "LOCAL" } ],"standard_charges":[{"minimum":1078.8900,"maximum":1078.8900,"gross_charge":1078.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1078.8900,"methodology":"fee schedule"}]}]},{"description":"C.PROFPERICARDIALWINDOW","code_information":[ { "code": "975000251", "type": "LOCAL" } ],"standard_charges":[{"minimum":758.8900,"maximum":758.8900,"gross_charge":758.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":758.8900,"methodology":"fee schedule"}]}]},{"description":"C.PROFPERICARDIECTOMY","code_information":[ { "code": "975000013", "type": "LOCAL" } ],"standard_charges":[{"minimum":1126.1300,"maximum":1126.1300,"gross_charge":1126.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1126.1300,"methodology":"fee schedule"}]}]},{"description":"C.PROFREP ATRIAL SEPTAL DEFEC","code_information":[ { "code": "975000055", "type": "LOCAL" } ],"standard_charges":[{"minimum":1620.0000,"maximum":1620.0000,"gross_charge":1620.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1620.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFREPL PULMONARY VALVE","code_information":[ { "code": "975000039", "type": "LOCAL" } ],"standard_charges":[{"minimum":1930.5400,"maximum":1930.5400,"gross_charge":1930.5400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1930.5400,"methodology":"fee schedule"}]}]},{"description":"C.PROFREPLAC AOR VAL ANNU ENL","code_information":[ { "code": "975000021", "type": "LOCAL" } ],"standard_charges":[{"minimum":2154.7500,"maximum":2154.7500,"gross_charge":2154.7500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2154.7500,"methodology":"fee schedule"}]}]},{"description":"C.PROFREPLAc ORVALVE;WI CPB","code_information":[ { "code": "975000019", "type": "LOCAL" } ],"standard_charges":[{"minimum":2778.7500,"maximum":2778.7500,"gross_charge":2778.7500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2778.7500,"methodology":"fee schedule"}]}]},{"description":"C.PROFREPLACEMITRAL VALVE","code_information":[ { "code": "975000031", "type": "LOCAL" } ],"standard_charges":[{"minimum":1950.0000,"maximum":1950.0000,"gross_charge":1950.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1950.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFRESECT MEDIASTINAL TUMO","code_information":[ { "code": "975000077", "type": "LOCAL" } ],"standard_charges":[{"minimum":970.0000,"maximum":970.0000,"gross_charge":970.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":970.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFSUBS HOSPITAL CARE","code_information":[ { "code": "975000125", "type": "LOCAL" } ],"standard_charges":[{"minimum":99.9600,"maximum":99.9600,"gross_charge":99.9600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.9600,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHERAPEUTIC WEDGE RESEC","code_information":[ { "code": "975000009", "type": "LOCAL" } ],"standard_charges":[{"minimum":737.1000,"maximum":737.1000,"gross_charge":737.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":737.1000,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOEXCISIPLICATIB","code_information":[ { "code": "975000199", "type": "LOCAL" } ],"standard_charges":[{"minimum":943.9200,"maximum":943.9200,"gross_charge":943.9200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":943.9200,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOLUNGPLEURALWBI","code_information":[ { "code": "975000185", "type": "LOCAL" } ],"standard_charges":[{"minimum":302.3200,"maximum":302.3200,"gross_charge":302.3200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":302.3200,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPMEDIASTINALYM","code_information":[ { "code": "975000135", "type": "LOCAL" } ],"standard_charges":[{"minimum":209.7000,"maximum":209.7000,"gross_charge":209.7000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":209.7000,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYCREATIONPERI","code_information":[ { "code": "975000245", "type": "LOCAL" } ],"standard_charges":[{"minimum":726.8900,"maximum":726.8900,"gross_charge":726.8900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":726.8900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYDIAGBIOPSYPL","code_information":[ { "code": "975000191", "type": "LOCAL" } ],"standard_charges":[{"minimum":251.1900,"maximum":251.1900,"gross_charge":251.1900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYEXCISIONMEDI","code_information":[ { "code": "975000151", "type": "LOCAL" } ],"standard_charges":[{"minimum":882.7400,"maximum":882.7400,"gross_charge":882.7400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":882.7400,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYSURGWEXCNOFP","code_information":[ { "code": "975000247", "type": "LOCAL" } ],"standard_charges":[{"minimum":789.2500,"maximum":789.2500,"gross_charge":789.2500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":789.2500,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYTHORACICSYMP","code_information":[ { "code": "975000249", "type": "LOCAL" } ],"standard_charges":[{"minimum":837.4500,"maximum":837.4500,"gross_charge":837.4500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":837.4500,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYWBIOPLUNGINF","code_information":[ { "code": "975000187", "type": "LOCAL" } ],"standard_charges":[{"minimum":301.6500,"maximum":301.6500,"gross_charge":301.6500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.6500,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYWBIOPLUNGMAS","code_information":[ { "code": "975000189", "type": "LOCAL" } ],"standard_charges":[{"minimum":251.1900,"maximum":251.1900,"gross_charge":251.1900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOPYWESOPHAGOMYO","code_information":[ { "code": "975000235", "type": "LOCAL" } ],"standard_charges":[{"minimum":1210.7100,"maximum":1210.7100,"gross_charge":1210.7100,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1210.7100,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOREMOVASINGLLUN","code_information":[ { "code": "975000131", "type": "LOCAL" } ],"standard_charges":[{"minimum":1318.7900,"maximum":1318.7900,"gross_charge":1318.7900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1318.7900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOSURGICALWOBECT","code_information":[ { "code": "975000127", "type": "LOCAL" } ],"standard_charges":[{"minimum":1373.2900,"maximum":1373.2900,"gross_charge":1373.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1373.2900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOTHERAPEUWEDGEE","code_information":[ { "code": "975000129", "type": "LOCAL" } ],"standard_charges":[{"minimum":859.1600,"maximum":859.1600,"gross_charge":859.1600,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":859.1600,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCOWPARIETALRECTO","code_information":[ { "code": "975000201", "type": "LOCAL" } ],"standard_charges":[{"minimum":794.0200,"maximum":794.0200,"gross_charge":794.0200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":794.0200,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCSURGICALWPLEURO","code_information":[ { "code": "975000193", "type": "LOCAL" } ],"standard_charges":[{"minimum":662.0500,"maximum":662.0500,"gross_charge":662.0500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":662.0500,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOSCWITHTHERAPEUTWE","code_information":[ { "code": "975000133", "type": "LOCAL" } ],"standard_charges":[{"minimum":152.5400,"maximum":152.5400,"gross_charge":152.5400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":152.5400,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHORACOTOMY LUNG NODULE","code_information":[ { "code": "975000003", "type": "LOCAL" } ],"standard_charges":[{"minimum":393.0700,"maximum":393.0700,"gross_charge":393.0700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":393.0700,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHROMBOENDARTERECTOMY","code_information":[ { "code": "975000071", "type": "LOCAL" } ],"standard_charges":[{"minimum":1535.6300,"maximum":1535.6300,"gross_charge":1535.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1535.6300,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHYMETRANSTHORAAPPROACH","code_information":[ { "code": "975000155", "type": "LOCAL" } ],"standard_charges":[{"minimum":1112.2900,"maximum":1112.2900,"gross_charge":1112.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1112.2900,"methodology":"fee schedule"}]}]},{"description":"C.PROFTHYMUSRESECTIONVIATHORAC","code_information":[ { "code": "975000153", "type": "LOCAL" } ],"standard_charges":[{"minimum":1195.4800,"maximum":1195.4800,"gross_charge":1195.4800,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1195.4800,"methodology":"fee schedule"}]}]},{"description":"C.PROFTOTALPULMONADECORTICATIO","code_information":[ { "code": "975000197", "type": "LOCAL" } ],"standard_charges":[{"minimum":1634.1300,"maximum":1634.1300,"gross_charge":1634.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1634.1300,"methodology":"fee schedule"}]}]},{"description":"C.PROFTRACHEOSTOMYPLANNED","code_information":[ { "code": "975000157", "type": "LOCAL" } ],"standard_charges":[{"minimum":301.8400,"maximum":301.8400,"gross_charge":301.8400,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.8400,"methodology":"fee schedule"}]}]},{"description":"C.PROFTRANSCATjAOR(TAVR\/TAVI)","code_information":[ { "code": "975000017", "type": "LOCAL" } ],"standard_charges":[{"minimum":1007.0000,"maximum":1007.0000,"gross_charge":1007.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1007.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROFTRANSV AOR ARCH WI CPB","code_information":[ { "code": "975000063", "type": "LOCAL" } ],"standard_charges":[{"minimum":2690.6300,"maximum":2690.6300,"gross_charge":2690.6300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2690.6300,"methodology":"fee schedule"}]}]},{"description":"C.PROFTUBE THORACOSTOMY","code_information":[ { "code": "975000119", "type": "LOCAL" } ],"standard_charges":[{"minimum":211.0000,"maximum":211.0000,"gross_charge":211.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":211.0000,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 10 MI REG PA","code_information":[ { "code": "975000093", "type": "LOCAL" } ],"standard_charges":[{"minimum":43.3900,"maximum":43.3900,"gross_charge":43.3900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.3900,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 15 MI REG PA","code_information":[ { "code": "975000095", "type": "LOCAL" } ],"standard_charges":[{"minimum":53.4900,"maximum":53.4900,"gross_charge":53.4900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":53.4900,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 20 MI NEW PA","code_information":[ { "code": "975000083", "type": "LOCAL" } ],"standard_charges":[{"minimum":52.2900,"maximum":52.2900,"gross_charge":52.2900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":52.2900,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 25 MI REG PA","code_information":[ { "code": "975000097", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.5700,"maximum":77.5700,"gross_charge":77.5700,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.5700,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 30 MI NEW PA","code_information":[ { "code": "975000085", "type": "LOCAL" } ],"standard_charges":[{"minimum":85.1300,"maximum":85.1300,"gross_charge":85.1300,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.1300,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 40 MI REG PA","code_information":[ { "code": "975000099", "type": "LOCAL" } ],"standard_charges":[{"minimum":98.4200,"maximum":98.4200,"gross_charge":98.4200,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":98.4200,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 45 MI NEW PA","code_information":[ { "code": "975000087", "type": "LOCAL" } ],"standard_charges":[{"minimum":139.3500,"maximum":139.3500,"gross_charge":139.3500,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":139.3500,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 5 MI REG PA","code_information":[ { "code": "975000091", "type": "LOCAL" } ],"standard_charges":[{"minimum":32.1000,"maximum":32.1000,"gross_charge":32.1000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":32.1000,"methodology":"fee schedule"}]}]},{"description":"C.PROOFF OP VISIT 60 MI NEW PA","code_information":[ { "code": "975000089", "type": "LOCAL" } ],"standard_charges":[{"minimum":148.1900,"maximum":148.1900,"gross_charge":148.1900,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":148.1900,"methodology":"fee schedule"}]}]},{"description":"Calcium Alginate Dressing 4 X 4","code_information":[ { "code": "2709142", "type": "LOCAL" } ],"standard_charges":[{"minimum":65.4900,"maximum":65.4900,"gross_charge":65.4900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":65.4900,"methodology":"fee schedule"}]}]},{"description":"Cannula Arterial 45 Tip Vented 3\/8","code_information":[ { "code": "2710230", "type": "LOCAL" } ],"standard_charges":[{"minimum":29.7500,"maximum":29.7500,"gross_charge":29.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.7500,"methodology":"fee schedule"}]}]},{"description":"Cannula Mc2 Venn 28\/36Fr","code_information":[ { "code": "2706330", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"}]}]},{"description":"Capsure EPI 4968-35 cm","code_information":[ { "code": "2700317", "type": "LOCAL" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Fix vus MRI Sure Scan","code_information":[ { "code": "2700329", "type": "LOCAL" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Fix vus MRI SureScan","code_information":[ { "code": "2711312", "type": "LOCAL" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Sense MRI SureScan 4074-58 cm","code_information":[ { "code": "2700313", "type": "LOCAL" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"CapSure Sense MRI SureScan 4574-53 cm","code_information":[ { "code": "2700326", "type": "LOCAL" } ],"standard_charges":[{"minimum":637.0000,"maximum":637.0000,"gross_charge":637.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":637.0000,"methodology":"fee schedule"}]}]},{"description":"Captura Biopsy Forceps W Spike 160 cm","code_information":[ { "code": "2700455", "type": "LOCAL" } ],"standard_charges":[{"minimum":266.0000,"maximum":266.0000,"gross_charge":266.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":266.0000,"methodology":"fee schedule"}]}]},{"description":"Captura Biopsy Forceps With Spike 230","code_information":[ { "code": "270001143", "type": "LOCAL" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioplegia Cannula 16 Ga","code_information":[ { "code": "2703860", "type": "LOCAL" } ],"standard_charges":[{"minimum":230.0000,"maximum":230.0000,"gross_charge":230.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":230.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioplegia Needle (12g\/16g)","code_information":[ { "code": "2702375", "type": "LOCAL" } ],"standard_charges":[{"minimum":19.6000,"maximum":19.6000,"gross_charge":19.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.6000,"methodology":"fee schedule"}]}]},{"description":"Cardioplegia Pack Perfusion","code_information":[ { "code": "2740005", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiopulmonary Bypass Perfusion","code_information":[ { "code": "360001727", "type": "LOCAL" } ],"standard_charges":[{"minimum":3107.9300,"maximum":3107.9300,"gross_charge":3107.9300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3107.9300,"methodology":"fee schedule"}]}]},{"description":"Cardiore Forceps","code_information":[ { "code": "3021116", "type": "LOCAL" } ],"standard_charges":[{"minimum":3969.0000,"maximum":3969.0000,"gross_charge":3969.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3969.0000,"methodology":"fee schedule"}]}]},{"description":"Cardioroot Woven Collagen Coated","code_information":[ { "code": "2890204", "type": "LOCAL" } ],"standard_charges":[{"minimum":4480.0000,"maximum":4480.0000,"gross_charge":4480.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4480.0000,"methodology":"fee schedule"}]}]},{"description":"Cardiotomy Reservoir","code_information":[ { "code": "2703070", "type": "LOCAL" } ],"standard_charges":[{"minimum":150.0000,"maximum":150.0000,"gross_charge":150.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":150.0000,"methodology":"fee schedule"}]}]},{"description":"C-ARM Drape","code_information":[ { "code": "2703025", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.0900,"maximum":6.0900,"gross_charge":6.0900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0900,"methodology":"fee schedule"}]}]},{"description":"Carotid Artery Loop Shunt","code_information":[ { "code": "270001145", "type": "LOCAL" } ],"standard_charges":[{"minimum":34.3000,"maximum":34.3000,"gross_charge":34.3000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":34.3000,"methodology":"fee schedule"}]}]},{"description":"Cartridge MAQ ACT","code_information":[ { "code": "2709605", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.5800,"maximum":2.5800,"gross_charge":2.5800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.5800,"methodology":"fee schedule"}]}]},{"description":"Cast Padding (REF. 9034 72303-01) BSN","code_information":[ { "code": "270001147", "type": "LOCAL" } ],"standard_charges":[{"minimum":27.9300,"maximum":27.9300,"gross_charge":27.9300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27.9300,"methodology":"fee schedule"}]}]},{"description":"Catheter 227F3 Freezor XTRA3 MED7F","code_information":[ { "code": "3019976", "type": "LOCAL" } ],"standard_charges":[{"minimum":1470.0000,"maximum":1470.0000,"gross_charge":1470.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1470.0000,"methodology":"fee schedule"}]}]},{"description":"Cath-Secure Plus","code_information":[ { "code": "3018155", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.9400,"maximum":2.9400,"gross_charge":2.9400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.9400,"methodology":"fee schedule"}]}]},{"description":"Cauteries model DCFT2","code_information":[ { "code": "2701611", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.1000,"maximum":2.1000,"gross_charge":2.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1000,"methodology":"fee schedule"}]}]},{"description":"Cautery Electrode Tip Cleaner","code_information":[ { "code": "270000297", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.3800,"maximum":2.3800,"gross_charge":2.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"}]}]},{"description":"Cautery Hand Electrosurgical Pencil","code_information":[ { "code": "270000299", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.6000,"maximum":5.6000,"gross_charge":5.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"}]}]},{"description":"Cautery Rocker Pencil 15'' (4.5m)","code_information":[ { "code": "2700157", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.5600,"maximum":7.5600,"gross_charge":7.5600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.5600,"methodology":"fee schedule"}]}]},{"description":"Cell Saver Perfusion Services","code_information":[ { "code": "2740015", "type": "LOCAL" } ],"standard_charges":[{"minimum":17.2500,"maximum":17.2500,"gross_charge":17.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.2500,"methodology":"fee schedule"}]}]},{"description":"Cellerate RX Surgical Activated","code_information":[ { "code": "270001149", "type": "LOCAL" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"}]}]},{"description":"Central Line Dressing Change Tray With","code_information":[ { "code": "270000301", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.3800,"maximum":5.3800,"gross_charge":5.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"}]}]},{"description":"Central Line Dressing Change Tray With","code_information":[ { "code": "270001105", "type": "LOCAL" } ],"standard_charges":[{"minimum":17.8700,"maximum":17.8700,"gross_charge":17.8700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.8700,"methodology":"fee schedule"}]}]},{"description":"Central Line Insertion Pack (Atados)","code_information":[ { "code": "2770012", "type": "LOCAL" } ],"standard_charges":[{"minimum":23.3200,"maximum":23.3200,"gross_charge":23.3200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.3200,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0 fr\/5","code_information":[ { "code": "2708243", "type": "LOCAL" } ],"standard_charges":[{"minimum":137.2000,"maximum":137.2000,"gross_charge":137.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":137.2000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0Fr\/5cm","code_information":[ { "code": "270000303", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 3.0Fr\/8cm","code_information":[ { "code": "270000305", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 4.0Fr\/12cm","code_information":[ { "code": "270000307", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Catheter Set 5.0Fr\/15cm","code_information":[ { "code": "270000309", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000311", "type": "LOCAL" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"}]}]},{"description":"Central Veus Tray Double Lumen","code_information":[ { "code": "270000313", "type": "LOCAL" } ],"standard_charges":[{"minimum":131.6000,"maximum":131.6000,"gross_charge":131.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":131.6000,"methodology":"fee schedule"}]}]},{"description":"Cetacaine Topical Anesthetic Spray","code_information":[ { "code": "270001151", "type": "LOCAL" } ],"standard_charges":[{"minimum":72.6500,"maximum":72.6500,"gross_charge":72.6500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":72.6500,"methodology":"fee schedule"}]}]},{"description":"CG FUTURE Annuloplasty Ring 638R 24 mm","code_information":[ { "code": "3021046", "type": "LOCAL" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"ChloraPrep Swabs-Ticks 2%","code_information":[ { "code": "270000315", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.8900,"maximum":1.8900,"gross_charge":1.8900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8900,"methodology":"fee schedule"}]}]},{"description":"Chlorhexidine Gluconate 2% Solution","code_information":[ { "code": "270000317", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.1200,"maximum":5.1200,"gross_charge":5.1200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.1200,"methodology":"fee schedule"}]}]},{"description":"Chlorhexidine Gluconate 4% Sol.","code_information":[ { "code": "3018184", "type": "LOCAL" } ],"standard_charges":[{"minimum":15.7500,"maximum":15.7500,"gross_charge":15.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15.7500,"methodology":"fee schedule"}]}]},{"description":"Chlorhexidine Gluconate Cloths 2%","code_information":[ { "code": "270000319", "type": "LOCAL" } ],"standard_charges":[{"minimum":17.4700,"maximum":17.4700,"gross_charge":17.4700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.4700,"methodology":"fee schedule"}]}]},{"description":"Cidex OPA","code_information":[ { "code": "2702250", "type": "LOCAL" } ],"standard_charges":[{"minimum":39.7300,"maximum":39.7300,"gross_charge":39.7300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.7300,"methodology":"fee schedule"}]}]},{"description":"Claria MRI CRT-D SureScan DTMA1D1","code_information":[ { "code": "3019127", "type": "LOCAL" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"}]}]},{"description":"Claria MRI QUAD CRT-D SureScan DTMA1Q1","code_information":[ { "code": "3019577", "type": "LOCAL" } ],"standard_charges":[{"minimum":13300.0000,"maximum":13300.0000,"gross_charge":13300.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13300.0000,"methodology":"fee schedule"}]}]},{"description":"CO- Set Room Temperature System","code_information":[ { "code": "2701461", "type": "LOCAL" } ],"standard_charges":[{"minimum":37.8000,"maximum":37.8000,"gross_charge":37.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.8000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT DR MRI SureScan DDPA2D4","code_information":[ { "code": "3019304", "type": "LOCAL" } ],"standard_charges":[{"minimum":15393.0000,"maximum":15393.0000,"gross_charge":15393.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15393.0000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT HF CRT-D MRI SureScan","code_information":[ { "code": "3019873", "type": "LOCAL" } ],"standard_charges":[{"minimum":16793.0000,"maximum":16793.0000,"gross_charge":16793.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16793.0000,"methodology":"fee schedule"}]}]},{"description":"Cobalt XT VR MRI Sure Scan DVPA2D4","code_information":[ { "code": "3019303", "type": "LOCAL" } ],"standard_charges":[{"minimum":13993.0000,"maximum":13993.0000,"gross_charge":13993.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13993.0000,"methodology":"fee schedule"}]}]},{"description":"Coda Balloon Catheter, 9 Fr, 120 cm L","code_information":[ { "code": "270000321", "type": "LOCAL" } ],"standard_charges":[{"minimum":826.0000,"maximum":826.0000,"gross_charge":826.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":826.0000,"methodology":"fee schedule"}]}]},{"description":"Combine Pad (Abdominal Pad 8 X 10","code_information":[ { "code": "2710325", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.5700,"maximum":0.5700,"gross_charge":0.5700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5700,"methodology":"fee schedule"}]}]},{"description":"Con D Perfusion X Straight W L (","code_information":[ { "code": "2707215", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.0200,"maximum":6.0200,"gross_charge":6.0200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0200,"methodology":"fee schedule"}]}]},{"description":"Conectores Rectos","code_information":[ { "code": "2750128", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.4600,"maximum":2.4600,"gross_charge":2.4600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"}]}]},{"description":"Confida Brecker Guideware 30mm X 260cm","code_information":[ { "code": "270001153", "type": "LOCAL" } ],"standard_charges":[{"minimum":274.4000,"maximum":274.4000,"gross_charge":274.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":274.4000,"methodology":"fee schedule"}]}]},{"description":"Confirm RX","code_information":[ { "code": "3019024", "type": "LOCAL" } ],"standard_charges":[{"minimum":3480.0000,"maximum":3480.0000,"gross_charge":3480.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3480.0000,"methodology":"fee schedule"}]}]},{"description":"Connector 1\/2 X 1\/2 X 3\/8","code_information":[ { "code": "2701095", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.0100,"maximum":8.0100,"gross_charge":8.0100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.0100,"methodology":"fee schedule"}]}]},{"description":"Connector 1\/2 X 3\/8 X 3\/8","code_information":[ { "code": "2701090", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2800,"maximum":0.2800,"gross_charge":0.2800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"}]}]},{"description":"Connector Multidose Vial Adapter","code_information":[ { "code": "270000323", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.9000,"maximum":4.9000,"gross_charge":4.9000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.9000,"methodology":"fee schedule"}]}]},{"description":"Contegra 200 12mm (Model 200H12)","code_information":[ { "code": "2780680", "type": "LOCAL" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Continu-Flo Solution Set -Vented","code_information":[ { "code": "270000325", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.1800,"maximum":2.1800,"gross_charge":2.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.1800,"methodology":"fee schedule"}]}]},{"description":"Continu-Flo Solution Set With Duo-Vent","code_information":[ { "code": "270000327", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.4600,"maximum":2.4600,"gross_charge":2.4600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"}]}]},{"description":"Contour 3D 690R Annuloplasty Tricuspid","code_information":[ { "code": "2820125", "type": "LOCAL" } ],"standard_charges":[{"minimum":2100.0000,"maximum":2100.0000,"gross_charge":2100.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2100.0000,"methodology":"fee schedule"}]}]},{"description":"Convatec Life Cut-to-Fit","code_information":[ { "code": "2705388", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.9600,"maximum":3.9600,"gross_charge":3.9600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9600,"methodology":"fee schedule"}]}]},{"description":"Coronary Care Unit (CCU)","code_information":[ { "code": "210000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":1919.4000,"maximum":759.0000,"gross_charge":1919.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"per diem"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1919.4000,"methodology":"per diem"}]}]},{"description":"Coronary Ostial Perfusion Cannula #10","code_information":[ { "code": "3020680", "type": "LOCAL" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Cotton Tipped Wood Applicators","code_information":[ { "code": "270000329", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0400,"maximum":0.0400,"gross_charge":0.0400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"}]}]},{"description":"Cotton Umbilical Tape","code_information":[ { "code": "270001155", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.6000,"maximum":2.6000,"gross_charge":2.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.6000,"methodology":"fee schedule"}]}]},{"description":"Covered in Thermometer 1 Unit","code_information":[ { "code": "270000331", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0800,"maximum":0.0800,"gross_charge":0.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0800,"methodology":"fee schedule"}]}]},{"description":"Covertors Video Camara Drape","code_information":[ { "code": "270000333", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.3200,"maximum":5.3200,"gross_charge":5.3200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3200,"methodology":"fee schedule"}]}]},{"description":"CPB Custom Perfusion Pack","code_information":[ { "code": "2740000", "type": "LOCAL" } ],"standard_charges":[{"minimum":1285.2000,"maximum":1285.2000,"gross_charge":1285.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1285.2000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000025", "type": "LOCAL" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000335", "type": "LOCAL" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000337", "type": "LOCAL" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SL II Slittable Outer Guide","code_information":[ { "code": "270000339", "type": "LOCAL" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct SLII Slittable Outer Guide","code_information":[ { "code": "270000027", "type": "LOCAL" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Direct Universal Slittable Outer","code_information":[ { "code": "270000341", "type": "LOCAL" } ],"standard_charges":[{"minimum":357.0000,"maximum":357.0000,"gross_charge":357.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":357.0000,"methodology":"fee schedule"}]}]},{"description":"CPS Universal Slitter","code_information":[ { "code": "270000343", "type": "LOCAL" } ],"standard_charges":[{"minimum":23.8000,"maximum":23.8000,"gross_charge":23.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":23.8000,"methodology":"fee schedule"}]}]},{"description":"Cryo Aortic Heart Valve","code_information":[ { "code": "2710958", "type": "LOCAL" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"}]}]},{"description":"Cryo Cryo Femoral Vein","code_information":[ { "code": "2820137", "type": "LOCAL" } ],"standard_charges":[{"minimum":6619.2000,"maximum":6619.2000,"gross_charge":6619.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6619.2000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Heart Valve","code_information":[ { "code": "2780235", "type": "LOCAL" } ],"standard_charges":[{"minimum":9730.0000,"maximum":9730.0000,"gross_charge":9730.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9730.0000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Pact Thin","code_information":[ { "code": "3020837", "type": "LOCAL" } ],"standard_charges":[{"minimum":8850.8000,"maximum":8850.8000,"gross_charge":8850.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8850.8000,"methodology":"fee schedule"}]}]},{"description":"Cryo Pulmonary Patch","code_information":[ { "code": "2770105", "type": "LOCAL" } ],"standard_charges":[{"minimum":6112.4000,"maximum":6112.4000,"gross_charge":6112.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6112.4000,"methodology":"fee schedule"}]}]},{"description":"Cryoprecipitate, each unit","code_information":[ { "code": "P9012", "type": "LOCAL" } ],"standard_charges":[{"minimum":60.0000,"maximum":60.0000,"gross_charge":60.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":60.0000,"methodology":"fee schedule"}]}]},{"description":"Culture Swab Sterile Transport","code_information":[ { "code": "270000345", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.4900,"maximum":0.4900,"gross_charge":0.4900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"}]}]},{"description":"Curved Bipolar Dissector","code_information":[ { "code": "3021141", "type": "LOCAL" } ],"standard_charges":[{"minimum":5556.6000,"maximum":5556.6000,"gross_charge":5556.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5556.6000,"methodology":"fee schedule"}]}]},{"description":"Curved Chest Tube #32","code_information":[ { "code": "2701866", "type": "LOCAL" } ],"standard_charges":[{"minimum":20.0000,"maximum":20.0000,"gross_charge":20.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.0000,"methodology":"fee schedule"}]}]},{"description":"Decantor IV","code_information":[ { "code": "2740003", "type": "LOCAL" } ],"standard_charges":[{"minimum":19.9500,"maximum":19.9500,"gross_charge":19.9500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":19.9500,"methodology":"fee schedule"}]}]},{"description":"Defibrillator Pad","code_information":[ { "code": "2719860", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.8600,"maximum":6.8600,"gross_charge":6.8600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.8600,"methodology":"fee schedule"}]}]},{"description":"Delivery Catheter C315HIS","code_information":[ { "code": "270000029", "type": "LOCAL" } ],"standard_charges":[{"minimum":280.0000,"maximum":280.0000,"gross_charge":280.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":280.0000,"methodology":"fee schedule"}]}]},{"description":"Denture Case","code_information":[ { "code": "270000349", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.3600,"maximum":0.3600,"gross_charge":0.3600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"}]}]},{"description":"Dermabond Advanced 0.7 ML","code_information":[ { "code": "270000351", "type": "LOCAL" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"Dermacea Sterile Gauzes 4'' X 4''","code_information":[ { "code": "270000353", "type": "LOCAL" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"Dextrose 5% Injection USP 250 ML","code_information":[ { "code": "250000603", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7200,"maximum":3.7200,"gross_charge":3.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7200,"methodology":"fee schedule"}]}]},{"description":"D-fend Pro Water Trap, dark steel blue","code_information":[ { "code": "270000347", "type": "LOCAL" } ],"standard_charges":[{"minimum":13.5700,"maximum":13.5700,"gross_charge":13.5700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.5700,"methodology":"fee schedule"}]}]},{"description":"Diffusion Membrane Oxigenator","code_information":[ { "code": "2702468", "type": "LOCAL" } ],"standard_charges":[{"minimum":1164.3400,"maximum":1164.3400,"gross_charge":1164.3400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1164.3400,"methodology":"fee schedule"}]}]},{"description":"Diprivan Injectable Emulsion, USP 500","code_information":[ { "code": "2509378", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.7200,"maximum":6.7200,"gross_charge":6.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.7200,"methodology":"fee schedule"}]}]},{"description":"Disposable Cytology Brush","code_information":[ { "code": "270001157", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Disposable Fitted (stretchers)","code_information":[ { "code": "2700515", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0000,"maximum":2.0000,"gross_charge":2.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"}]}]},{"description":"Disposable OR Towel (Sterile Blue)","code_information":[ { "code": "270000355", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.5800,"maximum":1.5800,"gross_charge":1.5800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.5800,"methodology":"fee schedule"}]}]},{"description":"Disposable Patient Sheets","code_information":[ { "code": "2701080", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable (12ft)","code_information":[ { "code": "270000359", "type": "LOCAL" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable (8ft)","code_information":[ { "code": "270000357", "type": "LOCAL" } ],"standard_charges":[{"minimum":43.4000,"maximum":43.4000,"gross_charge":43.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":43.4000,"methodology":"fee schedule"}]}]},{"description":"Disposable Surgical Cable 301-CG(1)","code_information":[ { "code": "270000031", "type": "LOCAL" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Dormo-Strip","code_information":[ { "code": "270000361", "type": "LOCAL" } ],"standard_charges":[{"minimum":1330.0000,"maximum":1330.0000,"gross_charge":1330.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1330.0000,"methodology":"fee schedule"}]}]},{"description":"Double Key Connector","code_information":[ { "code": "2751129", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.4600,"maximum":2.4600,"gross_charge":2.4600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4600,"methodology":"fee schedule"}]}]},{"description":"Double Lumen 28 LT","code_information":[ { "code": "2703245", "type": "LOCAL" } ],"standard_charges":[{"minimum":116.4800,"maximum":116.4800,"gross_charge":116.4800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":116.4800,"methodology":"fee schedule"}]}]},{"description":"Double Transducer","code_information":[ { "code": "2712110", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Dover PVC Urethral Catheter 8Fr\/Ch","code_information":[ { "code": "270001159", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.5500,"maximum":0.5500,"gross_charge":0.5500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"}]}]},{"description":"Duo-Derm 4 X 5 Extra W\/a0h Border 10 X","code_information":[ { "code": "2710100", "type": "LOCAL" } ],"standard_charges":[{"minimum":17.7700,"maximum":17.7700,"gross_charge":17.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":17.7700,"methodology":"fee schedule"}]}]},{"description":"Duo-Derm CGF 6 x 6","code_information":[ { "code": "270000363", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.1200,"maximum":8.1200,"gross_charge":8.1200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"}]}]},{"description":"Durapore 1_x001C_","code_information":[ { "code": "2700657", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.3700,"maximum":1.3700,"gross_charge":1.3700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"}]}]},{"description":"Duraprep Surgical Solution","code_information":[ { "code": "270000365", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.2700,"maximum":7.2700,"gross_charge":7.2700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2700,"methodology":"fee schedule"}]}]},{"description":"Durata Defibrillation Lead 58 cm","code_information":[ { "code": "2790576", "type": "LOCAL" } ],"standard_charges":[{"minimum":2366.0000,"maximum":2366.0000,"gross_charge":2366.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2366.0000,"methodology":"fee schedule"}]}]},{"description":"Dyna Lube Lubricant Gel Net Wt (2.7g)","code_information":[ { "code": "270000367", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0700,"maximum":0.0700,"gross_charge":0.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0700,"methodology":"fee schedule"}]}]},{"description":"Dyna Lube Sterile 4 oz","code_information":[ { "code": "270000369", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.3000,"maximum":2.3000,"gross_charge":2.3000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endopath Staple Line","code_information":[ { "code": "270001161", "type": "LOCAL" } ],"standard_charges":[{"minimum":235.2000,"maximum":235.2000,"gross_charge":235.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":235.2000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021060", "type": "LOCAL" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021061", "type": "LOCAL" } ],"standard_charges":[{"minimum":170.8000,"maximum":170.8000,"gross_charge":170.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":170.8000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "3021095", "type": "LOCAL" } ],"standard_charges":[{"minimum":232.4000,"maximum":232.4000,"gross_charge":232.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":232.4000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270000371", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":7.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001167", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001171", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001173", "type": "LOCAL" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001175", "type": "LOCAL" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001177", "type": "LOCAL" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Endoscopic Linear Cutter","code_information":[ { "code": "270001179", "type": "LOCAL" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex 45 Articulating","code_information":[ { "code": "270000373", "type": "LOCAL" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Echelon flex powered plus articulating","code_information":[ { "code": "270000375", "type": "LOCAL" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex Powered Plus Compact","code_information":[ { "code": "270000377", "type": "LOCAL" } ],"standard_charges":[{"minimum":567.0000,"maximum":567.0000,"gross_charge":567.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":567.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon Flex Powered Vascular Stapler","code_information":[ { "code": "270000379", "type": "LOCAL" } ],"standard_charges":[{"minimum":595.0000,"maximum":595.0000,"gross_charge":595.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":595.0000,"methodology":"fee schedule"}]}]},{"description":"Echelon-Flex 60 Articulating","code_information":[ { "code": "270000381", "type": "LOCAL" } ],"standard_charges":[{"minimum":441.0000,"maximum":441.0000,"gross_charge":441.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":441.0000,"methodology":"fee schedule"}]}]},{"description":"Ecmo Membrane","code_information":[ { "code": "2780060", "type": "LOCAL" } ],"standard_charges":[{"minimum":1176.0000,"maximum":1176.0000,"gross_charge":1176.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1176.0000,"methodology":"fee schedule"}]}]},{"description":"Ecmo Tubing Pack (Pediatric)","code_information":[ { "code": "2780061", "type": "LOCAL" } ],"standard_charges":[{"minimum":1052.8000,"maximum":1052.8000,"gross_charge":1052.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1052.8000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System","code_information":[ { "code": "270000385", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 20mm","code_information":[ { "code": "270000383", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 26mm","code_information":[ { "code": "270000387", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Commander Delivery System 29mm","code_information":[ { "code": "270000389", "type": "LOCAL" } ],"standard_charges":[{"minimum":40.6000,"maximum":40.6000,"gross_charge":40.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":40.6000,"methodology":"fee schedule"}]}]},{"description":"Edwards Crimper","code_information":[ { "code": "270001181", "type": "LOCAL" } ],"standard_charges":[{"minimum":469.0000,"maximum":469.0000,"gross_charge":469.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":469.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards eSheath+Introducer Set","code_information":[ { "code": "2705070", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001373", "type": "LOCAL" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001375", "type": "LOCAL" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001377", "type": "LOCAL" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"Edwards SAPIEN 3 Ultra Transcatheter","code_information":[ { "code": "270001379", "type": "LOCAL" } ],"standard_charges":[{"minimum":29260.0000,"maximum":29260.0000,"gross_charge":29260.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29260.0000,"methodology":"fee schedule"}]}]},{"description":"EEA OrVil Auto Suture Transoral","code_information":[ { "code": "2760736", "type": "LOCAL" } ],"standard_charges":[{"minimum":539.6700,"maximum":539.6700,"gross_charge":539.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":539.6700,"methodology":"fee schedule"}]}]},{"description":"Elastic Bandage 2_x001D_ X 5\"","code_information":[ { "code": "2707004", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.3600,"maximum":3.3600,"gross_charge":3.3600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"}]}]},{"description":"Elastic Tape 2\" x 5 yd","code_information":[ { "code": "270000393", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.3600,"maximum":0.3600,"gross_charge":0.3600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.3600,"methodology":"fee schedule"}]}]},{"description":"Elasticon 2\" X 5_x001D_ YDS","code_information":[ { "code": "2704005", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0000,"maximum":3.0000,"gross_charge":3.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"}]}]},{"description":"Electrode Adult","code_information":[ { "code": "270000395", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.1000,"maximum":0.1000,"gross_charge":0.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.1000,"methodology":"fee schedule"}]}]},{"description":"Electrode Multifunction Pediatric","code_information":[ { "code": "2700902", "type": "LOCAL" } ],"standard_charges":[{"minimum":57.4000,"maximum":57.4000,"gross_charge":57.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":57.4000,"methodology":"fee schedule"}]}]},{"description":"Electrodes Ekg Pediatric","code_information":[ { "code": "2709620", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2800,"maximum":0.2800,"gross_charge":0.2800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"}]}]},{"description":"Ellipse DR Implantable Cardioverter","code_information":[ { "code": "3019129", "type": "LOCAL" } ],"standard_charges":[{"minimum":11905.6000,"maximum":11905.6000,"gross_charge":11905.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11905.6000,"methodology":"fee schedule"}]}]},{"description":"Ellipse VR Implantable Cardioverter","code_information":[ { "code": "30170052", "type": "LOCAL" } ],"standard_charges":[{"minimum":10294.2000,"maximum":10294.2000,"gross_charge":10294.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10294.2000,"methodology":"fee schedule"}]}]},{"description":"Emblem MRI S-ICD A219","code_information":[ { "code": "3017232", "type": "LOCAL" } ],"standard_charges":[{"minimum":18816.0000,"maximum":18816.0000,"gross_charge":18816.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18816.0000,"methodology":"fee schedule"}]}]},{"description":"Emblem S-ICD 3501 45 CM","code_information":[ { "code": "3017470", "type": "LOCAL" } ],"standard_charges":[{"minimum":2688.0000,"maximum":2688.0000,"gross_charge":2688.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2688.0000,"methodology":"fee schedule"}]}]},{"description":"Emerald Guidewire","code_information":[ { "code": "270000401", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"EMERALD Guidewire 150 cm x .035 in","code_information":[ { "code": "270000397", "type": "LOCAL" } ],"standard_charges":[{"minimum":14.5600,"maximum":14.5600,"gross_charge":14.5600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"}]}]},{"description":"Emerald Guidewire 150cm\/.038in","code_information":[ { "code": "270000399", "type": "LOCAL" } ],"standard_charges":[{"minimum":14.5600,"maximum":14.5600,"gross_charge":14.5600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.5600,"methodology":"fee schedule"}]}]},{"description":"Emergency Shunt Kit","code_information":[ { "code": "2706608", "type": "LOCAL" } ],"standard_charges":[{"minimum":33.6000,"maximum":33.6000,"gross_charge":33.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.6000,"methodology":"fee schedule"}]}]},{"description":"Encore 26 Advantage Kit Inflation","code_information":[ { "code": "270000403", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.8000,"maximum":58.8000,"gross_charge":58.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.8000,"methodology":"fee schedule"}]}]},{"description":"Endo Catch Specimen Retrieval Pouch 15","code_information":[ { "code": "3021169", "type": "LOCAL" } ],"standard_charges":[{"minimum":630.0000,"maximum":630.0000,"gross_charge":630.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":630.0000,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Articulating ref. egia45amt","code_information":[ { "code": "2800827", "type": "LOCAL" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Articulating ref. egia45avt","code_information":[ { "code": "2800995", "type": "LOCAL" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"Endo GIA Ultra Universal Stapler 12mm","code_information":[ { "code": "2800826", "type": "LOCAL" } ],"standard_charges":[{"minimum":282.7400,"maximum":282.7400,"gross_charge":282.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":282.7400,"methodology":"fee schedule"}]}]},{"description":"ENDO- SURGERY LINEAR STAPLER RELOAD","code_information":[ { "code": "270001183", "type": "LOCAL" } ],"standard_charges":[{"minimum":81.2500,"maximum":81.2500,"gross_charge":81.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":81.2500,"methodology":"fee schedule"}]}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000407", "type": "LOCAL" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Endopath Xcel with OPTIVIEW Techlogy","code_information":[ { "code": "270000409", "type": "LOCAL" } ],"standard_charges":[{"minimum":99.6400,"maximum":99.6400,"gross_charge":99.6400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":99.6400,"methodology":"fee schedule"}]}]},{"description":"Endoscope Mouthpiece-Lip Press 22 mm x","code_information":[ { "code": "270001197", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.3800,"maximum":2.3800,"gross_charge":2.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3800,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Cutter Reloads","code_information":[ { "code": "270001185", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001187", "type": "LOCAL" } ],"standard_charges":[{"minimum":82.8700,"maximum":82.8700,"gross_charge":82.8700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":82.8700,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Linear Stapler Reload 30","code_information":[ { "code": "270001189", "type": "LOCAL" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"ENDO-SURGERY LINEAR STAPLER RELOADS","code_information":[ { "code": "270001191", "type": "LOCAL" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001193", "type": "LOCAL" } ],"standard_charges":[{"minimum":63.0000,"maximum":63.0000,"gross_charge":63.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":63.0000,"methodology":"fee schedule"}]}]},{"description":"Endo-Surgery Reloadable Linear Cutter","code_information":[ { "code": "270001195", "type": "LOCAL" } ],"standard_charges":[{"minimum":194.2500,"maximum":194.2500,"gross_charge":194.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":194.2500,"methodology":"fee schedule"}]}]},{"description":"Endotracheal Tube 2.0 cuff","code_information":[ { "code": "2705640", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0700,"maximum":2.0700,"gross_charge":2.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"}]}]},{"description":"Endotracheal Tube 6.5 cuff","code_information":[ { "code": "270000413", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.7200,"maximum":1.7200,"gross_charge":1.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7200,"methodology":"fee schedule"}]}]},{"description":"Endotracheal Tube 7.0 cuff","code_information":[ { "code": "270000417", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.6700,"maximum":1.6700,"gross_charge":1.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6700,"methodology":"fee schedule"}]}]},{"description":"Endotracheal Tube 8.0 cuff","code_information":[ { "code": "270000419", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.7400,"maximum":1.7400,"gross_charge":1.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.7400,"methodology":"fee schedule"}]}]},{"description":"Endotracheal Tube 8.5 cuff","code_information":[ { "code": "2709040", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.5000,"maximum":3.5000,"gross_charge":3.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Instruments Suction","code_information":[ { "code": "3021115", "type": "LOCAL" } ],"standard_charges":[{"minimum":389.6700,"maximum":389.6700,"gross_charge":389.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":389.6700,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Stapler Gray 30mm 2.0mm","code_information":[ { "code": "3021145", "type": "LOCAL" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"}]}]},{"description":"EndoWrist Stapler White 30mm 2.5mm","code_information":[ { "code": "3021143", "type": "LOCAL" } ],"standard_charges":[{"minimum":251.1800,"maximum":251.1800,"gross_charge":251.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":251.1800,"methodology":"fee schedule"}]}]},{"description":"Endozime Sponge","code_information":[ { "code": "270001199", "type": "LOCAL" } ],"standard_charges":[{"minimum":322.0000,"maximum":322.0000,"gross_charge":322.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":322.0000,"methodology":"fee schedule"}]}]},{"description":"Endurant II Stent Graft System Limb","code_information":[ { "code": "2740173", "type": "LOCAL" } ],"standard_charges":[{"minimum":5880.0000,"maximum":5880.0000,"gross_charge":5880.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5880.0000,"methodology":"fee schedule"}]}]},{"description":"Enhance Transcarotid Peripheral Access","code_information":[ { "code": "3021036", "type": "LOCAL" } ],"standard_charges":[{"minimum":2646.0000,"maximum":2646.0000,"gross_charge":2646.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2646.0000,"methodology":"fee schedule"}]}]},{"description":"Enroute Enflate Transcarotid 5.5x25","code_information":[ { "code": "3021039", "type": "LOCAL" } ],"standard_charges":[{"minimum":530.6000,"maximum":530.6000,"gross_charge":530.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":530.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid 0.014 Guidewires","code_information":[ { "code": "3021035", "type": "LOCAL" } ],"standard_charges":[{"minimum":1477.0000,"maximum":1477.0000,"gross_charge":1477.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1477.0000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Neuroprotection","code_information":[ { "code": "3021034", "type": "LOCAL" } ],"standard_charges":[{"minimum":5248.6000,"maximum":5248.6000,"gross_charge":5248.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5248.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021037", "type": "LOCAL" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"}]}]},{"description":"Enroute Transcarotid Stent System","code_information":[ { "code": "3021038", "type": "LOCAL" } ],"standard_charges":[{"minimum":4058.6000,"maximum":4058.6000,"gross_charge":4058.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4058.6000,"methodology":"fee schedule"}]}]},{"description":"Enseal X1 Large Jaw Tissue Sealer 20","code_information":[ { "code": "270000423", "type": "LOCAL" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Ensemble II Transcatheter Valve","code_information":[ { "code": "3019046", "type": "LOCAL" } ],"standard_charges":[{"minimum":7000.0000,"maximum":7000.0000,"gross_charge":7000.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7000.0000,"methodology":"fee schedule"}]}]},{"description":"Enteral Feeding Tube 6 Fr","code_information":[ { "code": "2760098", "type": "LOCAL" } ],"standard_charges":[{"minimum":14.7500,"maximum":14.7500,"gross_charge":14.7500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14.7500,"methodology":"fee schedule"}]}]},{"description":"Erbe Nessy Plate Power Your","code_information":[ { "code": "3021289", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.2000,"maximum":7.2000,"gross_charge":7.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.2000,"methodology":"fee schedule"}]}]},{"description":"Esophageal Stethoscope Direct","code_information":[ { "code": "270001201", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.5400,"maximum":8.5400,"gross_charge":8.5400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.5400,"methodology":"fee schedule"}]}]},{"description":"Esophageal Stethoscope w\/ Temperature","code_information":[ { "code": "270001203", "type": "LOCAL" } ],"standard_charges":[{"minimum":10.0800,"maximum":10.0800,"gross_charge":10.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0800,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel MH Polter Suture 0","code_information":[ { "code": "270000427", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.1300,"maximum":6.1300,"gross_charge":6.1300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel Polter Suture 2-0","code_information":[ { "code": "270000429", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel SH Polter Suture 2-0","code_information":[ { "code": "270000431", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.7700,"maximum":58.7700,"gross_charge":58.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.7700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel SH Polter Suture 3-0","code_information":[ { "code": "270000433", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.9900,"maximum":3.9900,"gross_charge":3.9900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9900,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel SH-2 Polter Suture","code_information":[ { "code": "270000435", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.1300,"maximum":6.1300,"gross_charge":6.1300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000437", "type": "LOCAL" } ],"standard_charges":[{"minimum":46.0800,"maximum":46.0800,"gross_charge":46.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":46.0800,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000439", "type": "LOCAL" } ],"standard_charges":[{"minimum":33.4700,"maximum":33.4700,"gross_charge":149.1100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.4700,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-4 Polter Suture","code_information":[ { "code": "270000441", "type": "LOCAL" } ],"standard_charges":[{"minimum":149.1100,"maximum":149.1100,"gross_charge":33.4700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":149.1100,"methodology":"fee schedule"}]}]},{"description":"Ethibond Excel V-7 Polter Suture","code_information":[ { "code": "270000443", "type": "LOCAL" } ],"standard_charges":[{"minimum":178.9300,"maximum":178.9300,"gross_charge":178.9300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":178.9300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Linear Cutter","code_information":[ { "code": "3018401", "type": "LOCAL" } ],"standard_charges":[{"minimum":161.0000,"maximum":161.0000,"gross_charge":161.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":161.0000,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Linear Cutter","code_information":[ { "code": "270001205", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":6.5500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Linear Cutter","code_information":[ { "code": "270001207", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.5500,"maximum":6.5500,"gross_charge":7.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5500,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Proximate Linear","code_information":[ { "code": "270001209", "type": "LOCAL" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":86.0300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable","code_information":[ { "code": "270001217", "type": "LOCAL" } ],"standard_charges":[{"minimum":78.6700,"maximum":78.6700,"gross_charge":78.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.6700,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001211", "type": "LOCAL" } ],"standard_charges":[{"minimum":93.2200,"maximum":93.2200,"gross_charge":93.2200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":93.2200,"methodology":"fee schedule"}]}]},{"description":"Ethicon Endo-Surgery Reloadable Linear","code_information":[ { "code": "270001213", "type": "LOCAL" } ],"standard_charges":[{"minimum":86.0300,"maximum":86.0300,"gross_charge":86.0300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":86.0300,"methodology":"fee schedule"}]}]},{"description":"Ethicon Enseal X1 Shears Integrated 25","code_information":[ { "code": "270000445", "type": "LOCAL" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Ethicon Harmonic 1,100 Shears","code_information":[ { "code": "3019606", "type": "LOCAL" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"}]}]},{"description":"Ethilon 3-0 30'' Model 627H","code_information":[ { "code": "270000451", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.4900,"maximum":2.4900,"gross_charge":2.4900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4900,"methodology":"fee schedule"}]}]},{"description":"Ethilon 3-0 FS-1 18'' Model 663","code_information":[ { "code": "270000453", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.2400,"maximum":2.2400,"gross_charge":2.2400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2400,"methodology":"fee schedule"}]}]},{"description":"Ethilon 4-0 18'' Model 662H","code_information":[ { "code": "270000455", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.3900,"maximum":2.3900,"gross_charge":2.3900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.3900,"methodology":"fee schedule"}]}]},{"description":"Ethilon 4-0 30'' Model 626H","code_information":[ { "code": "270000457", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.3800,"maximum":5.3800,"gross_charge":5.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.3800,"methodology":"fee schedule"}]}]},{"description":"Evera MRI XT DR SureScan DDMB1D1","code_information":[ { "code": "2800870", "type": "LOCAL" } ],"standard_charges":[{"minimum":21966.0000,"maximum":21966.0000,"gross_charge":21966.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21966.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Delivery Catheter System","code_information":[ { "code": "270001219", "type": "LOCAL" } ],"standard_charges":[{"minimum":2240.0000,"maximum":2240.0000,"gross_charge":2240.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2240.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Delivery System 34 mm","code_information":[ { "code": "270001221", "type": "LOCAL" } ],"standard_charges":[{"minimum":812.0000,"maximum":812.0000,"gross_charge":812.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":812.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Loading System 23-29mm","code_information":[ { "code": "270000459", "type": "LOCAL" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Loading System 34mm","code_information":[ { "code": "270001357", "type": "LOCAL" } ],"standard_charges":[{"minimum":28000.0000,"maximum":28000.0000,"gross_charge":28000.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":28000.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020638", "type": "LOCAL" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020639", "type": "LOCAL" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020640", "type": "LOCAL" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Evolut FX Transcatheter Aortic Valve","code_information":[ { "code": "3020641", "type": "LOCAL" } ],"standard_charges":[{"minimum":33600.0000,"maximum":33600.0000,"gross_charge":33600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33600.0000,"methodology":"fee schedule"}]}]},{"description":"Extension Set With T","code_information":[ { "code": "2703320", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.2500,"maximum":2.2500,"gross_charge":2.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2500,"methodology":"fee schedule"}]}]},{"description":"Extension Set 34'' (86 cm),3.8 mL","code_information":[ { "code": "270000461", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.8300,"maximum":1.8300,"gross_charge":1.8300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"}]}]},{"description":"Extension Set With Control A-Flow","code_information":[ { "code": "270000463", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.8300,"maximum":1.8300,"gross_charge":1.8300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8300,"methodology":"fee schedule"}]}]},{"description":"Extra PVC Tubing (Sterile Tubing 6ft )","code_information":[ { "code": "2703610", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.0000,"maximum":4.0000,"gross_charge":4.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"}]}]},{"description":"Eye Acu.Dispo.Cautery High Temperature","code_information":[ { "code": "270001223", "type": "LOCAL" } ],"standard_charges":[{"minimum":77.0000,"maximum":77.0000,"gross_charge":77.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":77.0000,"methodology":"fee schedule"}]}]},{"description":"E-z Clean Blade Mod 4.0in","code_information":[ { "code": "3021045", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.9900,"maximum":6.9900,"gross_charge":6.9900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9900,"methodology":"fee schedule"}]}]},{"description":"Face Adult Mask","code_information":[ { "code": "270000467", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0100,"maximum":1.0100,"gross_charge":1.0100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0100,"methodology":"fee schedule"}]}]},{"description":"Face Mask Air Cushion Neonatal","code_information":[ { "code": "2740207", "type": "LOCAL" } ],"standard_charges":[{"minimum":9.8000,"maximum":9.8000,"gross_charge":9.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"}]}]},{"description":"Face Mask Pediatric","code_information":[ { "code": "2740209", "type": "LOCAL" } ],"standard_charges":[{"minimum":9.8000,"maximum":9.8000,"gross_charge":9.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.8000,"methodology":"fee schedule"}]}]},{"description":"Feeding Tube 22Fr","code_information":[ { "code": "2701405", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.0000,"maximum":4.0000,"gross_charge":4.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0000,"methodology":"fee schedule"}]}]},{"description":"Feeding Tube #5","code_information":[ { "code": "2701400", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.0000,"maximum":6.0000,"gross_charge":6.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.0000,"methodology":"fee schedule"}]}]},{"description":"Feeding Tube #8 Fr\/CH","code_information":[ { "code": "270001225", "type": "LOCAL" } ],"standard_charges":[{"minimum":26.6000,"maximum":26.6000,"gross_charge":26.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.6000,"methodology":"fee schedule"}]}]},{"description":"Femoral Angiography (Bundle)","code_information":[ { "code": "270000469", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"}]}]},{"description":"Femoral Arterial Cannula #15 Fr x 50cm","code_information":[ { "code": "2703325", "type": "LOCAL" } ],"standard_charges":[{"minimum":12.0000,"maximum":12.0000,"gross_charge":12.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.0000,"methodology":"fee schedule"}]}]},{"description":"Femoral Artery Catheter Set 4.0","code_information":[ { "code": "270000471", "type": "LOCAL" } ],"standard_charges":[{"minimum":58.2400,"maximum":58.2400,"gross_charge":58.2400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":58.2400,"methodology":"fee schedule"}]}]},{"description":"Fenestrated Bipolar Forceps","code_information":[ { "code": "3021118", "type": "LOCAL" } ],"standard_charges":[{"minimum":4116.0000,"maximum":4116.0000,"gross_charge":4116.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4116.0000,"methodology":"fee schedule"}]}]},{"description":"Fentanyl Citrate Injection, USP 100","code_information":[ { "code": "250000839", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1300,"maximum":1.1300,"gross_charge":1.1300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1300,"methodology":"fee schedule"}]}]},{"description":"Fentanyl Citrate Injection, USP 1000","code_information":[ { "code": "250000843", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.4900,"maximum":0.4900,"gross_charge":0.4900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.4900,"methodology":"fee schedule"}]}]},{"description":"Fentanyl Citrate Injection, USP 250","code_information":[ { "code": "250000841", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.6000,"maximum":0.6000,"gross_charge":0.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.6000,"methodology":"fee schedule"}]}]},{"description":"Filter Transfer Pack","code_information":[ { "code": "2702580", "type": "LOCAL" } ],"standard_charges":[{"minimum":7.0000,"maximum":7.0000,"gross_charge":7.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7.0000,"methodology":"fee schedule"}]}]},{"description":"Finishing Wire Supportrak Model 6668","code_information":[ { "code": "270000473", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Fixation Tool (Model 6616)","code_information":[ { "code": "270000475", "type": "LOCAL" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"Flats (Chatas)","code_information":[ { "code": "2770157", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.3100,"maximum":1.3100,"gross_charge":1.3100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3100,"methodology":"fee schedule"}]}]},{"description":"Flexi Flow 8 Fr 45\"","code_information":[ { "code": "2700132", "type": "LOCAL" } ],"standard_charges":[{"minimum":16.1000,"maximum":16.1000,"gross_charge":16.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.1000,"methodology":"fee schedule"}]}]},{"description":"Flexi-Trak Anchoring Device","code_information":[ { "code": "2760731", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.8600,"maximum":1.8600,"gross_charge":1.8600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.8600,"methodology":"fee schedule"}]}]},{"description":"Flexon 3-0 2592-43","code_information":[ { "code": "2705920", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.9600,"maximum":6.9600,"gross_charge":6.9600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.9600,"methodology":"fee schedule"}]}]},{"description":"Flexor Check-Flo Introducer Set 8Fr","code_information":[ { "code": "270000477", "type": "LOCAL" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":364.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"}]}]},{"description":"Fluid Trap Minivac Smk Evac","code_information":[ { "code": "3019903", "type": "LOCAL" } ],"standard_charges":[{"minimum":210.0000,"maximum":210.0000,"gross_charge":210.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":210.0000,"methodology":"fee schedule"}]}]},{"description":"Flush Syringe 5 ML","code_information":[ { "code": "2820521", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.5900,"maximum":0.5900,"gross_charge":0.5900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5900,"methodology":"fee schedule"}]}]},{"description":"Fogarty #2F","code_information":[ { "code": "270001227", "type": "LOCAL" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #3F","code_information":[ { "code": "270001229", "type": "LOCAL" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #4F","code_information":[ { "code": "270001231", "type": "LOCAL" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #5F","code_information":[ { "code": "270001233", "type": "LOCAL" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Fogarty #6F","code_information":[ { "code": "270001235", "type": "LOCAL" } ],"standard_charges":[{"minimum":113.4000,"maximum":113.4000,"gross_charge":113.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":113.4000,"methodology":"fee schedule"}]}]},{"description":"Foley Cath Tray #16fr\/5ml Covidien","code_information":[ { "code": "270000479", "type": "LOCAL" } ],"standard_charges":[{"minimum":12.9900,"maximum":12.9900,"gross_charge":12.9900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"}]}]},{"description":"Foley Catheter 24 Fr 2 Way Scc","code_information":[ { "code": "3006758", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.9700,"maximum":3.9700,"gross_charge":3.9700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.9700,"methodology":"fee schedule"}]}]},{"description":"Foley Catheter Silicone #14","code_information":[ { "code": "270000481", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.2700,"maximum":2.2700,"gross_charge":2.2700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.2700,"methodology":"fee schedule"}]}]},{"description":"Foley Catheter Tray 18 Fr.","code_information":[ { "code": "2700795", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.6600,"maximum":6.6600,"gross_charge":6.6600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.6600,"methodology":"fee schedule"}]}]},{"description":"Foley Gold (coude) #12 Teleflex","code_information":[ { "code": "270000483", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.4700,"maximum":6.4700,"gross_charge":6.4700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"}]}]},{"description":"Foley Gold (coude) #14","code_information":[ { "code": "2750230", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.5900,"maximum":5.5900,"gross_charge":5.5900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.5900,"methodology":"fee schedule"}]}]},{"description":"Foley Gold (coude) #16 Covidien","code_information":[ { "code": "270000485", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0000,"maximum":3.0000,"gross_charge":3.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0000,"methodology":"fee schedule"}]}]},{"description":"Foley Gold (coude) #18 Teleflex","code_information":[ { "code": "270000487", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.2500,"maximum":5.2500,"gross_charge":5.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone # 18 Dynarex","code_information":[ { "code": "270000489", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.4100,"maximum":4.4100,"gross_charge":4.4100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4100,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #10 Covidien","code_information":[ { "code": "270000491", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.1400,"maximum":11.1400,"gross_charge":11.1400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #10 Teleflex","code_information":[ { "code": "270000493", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.1400,"maximum":11.1400,"gross_charge":11.1400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.1400,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #12 C.R. BARD INC.","code_information":[ { "code": "270000495", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2900,"maximum":0.2900,"gross_charge":0.2900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2900,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #12 Teleflex","code_information":[ { "code": "270000497", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.4700,"maximum":6.4700,"gross_charge":6.4700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.4700,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #14 Teleflex","code_information":[ { "code": "270000499", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.6900,"maximum":8.6900,"gross_charge":8.6900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.6900,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #16 Covidien","code_information":[ { "code": "270000501", "type": "LOCAL" } ],"standard_charges":[{"minimum":12.9900,"maximum":12.9900,"gross_charge":12.9900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #16 Dynarex","code_information":[ { "code": "270000503", "type": "LOCAL" } ],"standard_charges":[{"minimum":12.9900,"maximum":12.9900,"gross_charge":12.9900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":12.9900,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #18 Covidien","code_information":[ { "code": "270000505", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.5800,"maximum":6.5800,"gross_charge":6.5800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.5800,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #6 Teleflex","code_information":[ { "code": "270000507", "type": "LOCAL" } ],"standard_charges":[{"minimum":26.9400,"maximum":26.9400,"gross_charge":26.9400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.9400,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #8 Covidien","code_information":[ { "code": "270000509", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.4400,"maximum":1.4400,"gross_charge":1.4400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"}]}]},{"description":"Foley Silicone #8 Teleflex","code_information":[ { "code": "270000511", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.4400,"maximum":1.4400,"gross_charge":1.4400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.4400,"methodology":"fee schedule"}]}]},{"description":"Formaline (mL)","code_information":[ { "code": "2700967", "type": "LOCAL" } ],"standard_charges":[{"minimum":22.4000,"maximum":22.4000,"gross_charge":22.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":22.4000,"methodology":"fee schedule"}]}]},{"description":"Freestyle 995 Bioprosthesis Aortic","code_information":[ { "code": "2702926", "type": "LOCAL" } ],"standard_charges":[{"minimum":5600.0000,"maximum":5600.0000,"gross_charge":5600.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5600.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma (single donor) each unit requisitioned to be AB positive","code_information":[ { "code": "P9017", "type": "LOCAL" } ],"standard_charges":[{"minimum":85.0000,"maximum":85.0000,"gross_charge":85.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":85.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.0000,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma between 8-24 hours of collection, each unit","code_information":[ { "code": "P9059", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Full access underbody 3M Bair hugger","code_information":[ { "code": "270000513", "type": "LOCAL" } ],"standard_charges":[{"minimum":37.1000,"maximum":37.1000,"gross_charge":37.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":37.1000,"methodology":"fee schedule"}]}]},{"description":"Full Access Underbody Adult","code_information":[ { "code": "270000515", "type": "LOCAL" } ],"standard_charges":[{"minimum":48.3700,"maximum":48.3700,"gross_charge":48.3700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":48.3700,"methodology":"fee schedule"}]}]},{"description":"Gallant HF CRT-D","code_information":[ { "code": "3019745", "type": "LOCAL" } ],"standard_charges":[{"minimum":16258.2000,"maximum":16258.2000,"gross_charge":16258.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16258.2000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Feeding Tube 12Fr","code_information":[ { "code": "270001237", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Feeding Tube 24 Fr","code_information":[ { "code": "270001239", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Gastrostomy Tube Feeding 14Fr","code_information":[ { "code": "2770971", "type": "LOCAL" } ],"standard_charges":[{"minimum":75.1800,"maximum":75.1800,"gross_charge":75.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":75.1800,"methodology":"fee schedule"}]}]},{"description":"Gauze 2X2 (n- Sterile)","code_information":[ { "code": "2709780", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"GDWR CGRXT190HS Cougar XT 5PK 190 ST","code_information":[ { "code": "2750403", "type": "LOCAL" } ],"standard_charges":[{"minimum":182.0000,"maximum":182.0000,"gross_charge":182.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":182.0000,"methodology":"fee schedule"}]}]},{"description":"Gigli Saw","code_information":[ { "code": "2705416", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.0000,"maximum":1.0000,"gross_charge":1.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.0000,"methodology":"fee schedule"}]}]},{"description":"Glide Scope BFlex 3.8","code_information":[ { "code": "3021309", "type": "LOCAL" } ],"standard_charges":[{"minimum":442.4000,"maximum":442.4000,"gross_charge":442.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":442.4000,"methodology":"fee schedule"}]}]},{"description":"Glide Sheath Basic 5fr\/100cm","code_information":[ { "code": "2820986", "type": "LOCAL" } ],"standard_charges":[{"minimum":110.6000,"maximum":110.6000,"gross_charge":110.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":110.6000,"methodology":"fee schedule"}]}]},{"description":"Glidecath Angled Taper 5Fr\/100cm","code_information":[ { "code": "270000517", "type": "LOCAL" } ],"standard_charges":[{"minimum":61.1700,"maximum":61.1700,"gross_charge":61.1700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":61.1700,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath Size 14F","code_information":[ { "code": "270000519", "type": "LOCAL" } ],"standard_charges":[{"minimum":3391.5000,"maximum":3391.5000,"gross_charge":3391.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3391.5000,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath, 12F","code_information":[ { "code": "270000521", "type": "LOCAL" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"}]}]},{"description":"GlideLight Laser Sheath, 16F","code_information":[ { "code": "270000523", "type": "LOCAL" } ],"standard_charges":[{"minimum":3390.8000,"maximum":3390.8000,"gross_charge":3390.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3390.8000,"methodology":"fee schedule"}]}]},{"description":"GLIDESHEAT Hydrophilic Coated","code_information":[ { "code": "270000525", "type": "LOCAL" } ],"standard_charges":[{"minimum":92.4000,"maximum":92.4000,"gross_charge":92.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":92.4000,"methodology":"fee schedule"}]}]},{"description":"Glideware Advantage","code_information":[ { "code": "270000527", "type": "LOCAL" } ],"standard_charges":[{"minimum":301.0000,"maximum":301.0000,"gross_charge":301.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":301.0000,"methodology":"fee schedule"}]}]},{"description":"Glidewire Cath. Exchange","code_information":[ { "code": "270000529", "type": "LOCAL" } ],"standard_charges":[{"minimum":47.6000,"maximum":47.6000,"gross_charge":47.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":47.6000,"methodology":"fee schedule"}]}]},{"description":"Glydo Lidocaine Jelly 2%","code_information":[ { "code": "270000531", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.0800,"maximum":4.0800,"gross_charge":4.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.0800,"methodology":"fee schedule"}]}]},{"description":"Gold Probe 350 cm Electrical Connector","code_information":[ { "code": "270001241", "type": "LOCAL" } ],"standard_charges":[{"minimum":259.0000,"maximum":259.0000,"gross_charge":259.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":259.0000,"methodology":"fee schedule"}]}]},{"description":"Gore Acuaseal Cardiovascular Patch","code_information":[ { "code": "2720027", "type": "LOCAL" } ],"standard_charges":[{"minimum":70.0000,"maximum":70.0000,"gross_charge":70.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":70.0000,"methodology":"fee schedule"}]}]},{"description":"Gore Acuseal Cardiovascular Patch","code_information":[ { "code": "2720930", "type": "LOCAL" } ],"standard_charges":[{"minimum":445.2000,"maximum":445.2000,"gross_charge":445.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":445.2000,"methodology":"fee schedule"}]}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "3021048", "type": "LOCAL" } ],"standard_charges":[{"minimum":634.2000,"maximum":634.2000,"gross_charge":634.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":634.2000,"methodology":"fee schedule"}]}]},{"description":"GORE DrySeal Flex Introducer Sheath","code_information":[ { "code": "8017780", "type": "LOCAL" } ],"standard_charges":[{"minimum":364.0000,"maximum":364.0000,"gross_charge":634.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":364.0000,"methodology":"fee schedule"}]}]},{"description":"Gore Dualmesh Biomaterial 26.0 cm x","code_information":[ { "code": "2710811", "type": "LOCAL" } ],"standard_charges":[{"minimum":2433.2000,"maximum":2433.2000,"gross_charge":2433.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2433.2000,"methodology":"fee schedule"}]}]},{"description":"GORE EXCLUDER AAA Endoprosthesis","code_information":[ { "code": "3019130", "type": "LOCAL" } ],"standard_charges":[{"minimum":11603.2000,"maximum":11603.2000,"gross_charge":11603.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11603.2000,"methodology":"fee schedule"}]}]},{"description":"GORE Excluder Conformable AAA","code_information":[ { "code": "3021206", "type": "LOCAL" } ],"standard_charges":[{"minimum":14074.2000,"maximum":14074.2000,"gross_charge":14074.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":14074.2000,"methodology":"fee schedule"}]}]},{"description":"GORE PRECLUDE Pericardial Membrane","code_information":[ { "code": "2700226", "type": "LOCAL" } ],"standard_charges":[{"minimum":462.0000,"maximum":462.0000,"gross_charge":462.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":462.0000,"methodology":"fee schedule"}]}]},{"description":"GORE PROPATEN Vascular Graft","code_information":[ { "code": "2750234", "type": "LOCAL" } ],"standard_charges":[{"minimum":1939.0000,"maximum":1939.0000,"gross_charge":1939.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1939.0000,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX CV-3","code_information":[ { "code": "270001245", "type": "LOCAL" } ],"standard_charges":[{"minimum":947.8000,"maximum":947.8000,"gross_charge":947.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":947.8000,"methodology":"fee schedule"}]}]},{"description":"Gore-Tex Stretch Vascular Graft 6 mm x","code_information":[ { "code": "2710897", "type": "LOCAL" } ],"standard_charges":[{"minimum":1050.0000,"maximum":1050.0000,"gross_charge":1050.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1050.0000,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX Suture CV-5","code_information":[ { "code": "270001247", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"}]}]},{"description":"GORE-TEX Suture CV-6","code_information":[ { "code": "270001249", "type": "LOCAL" } ],"standard_charges":[{"minimum":33.9100,"maximum":33.9100,"gross_charge":33.9100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":33.9100,"methodology":"fee schedule"}]}]},{"description":"GOR-TEX CV-4 Suture","code_information":[ { "code": "270001243", "type": "LOCAL" } ],"standard_charges":[{"minimum":30.2900,"maximum":30.2900,"gross_charge":30.2900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":30.2900,"methodology":"fee schedule"}]}]},{"description":"Graft Sizers Size 05 mm- 24 mm","code_information":[ { "code": "270001251", "type": "LOCAL" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Graft Sizers Size 24 mm- 38 mm","code_information":[ { "code": "270000533", "type": "LOCAL" } ],"standard_charges":[{"minimum":49.0000,"maximum":49.0000,"gross_charge":49.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":49.0000,"methodology":"fee schedule"}]}]},{"description":"Green Tube 5 ML","code_information":[ { "code": "2707250", "type": "LOCAL" } ],"standard_charges":[{"minimum":10.0000,"maximum":10.0000,"gross_charge":10.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":10.0000,"methodology":"fee schedule"}]}]},{"description":"Guidewire GWBC30 Confida 29L 3YSL","code_information":[ { "code": "3017622", "type": "LOCAL" } ],"standard_charges":[{"minimum":218.4000,"maximum":218.4000,"gross_charge":218.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":218.4000,"methodology":"fee schedule"}]}]},{"description":"Guidewire Introducer Needle 18 ga","code_information":[ { "code": "270001349", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.5000,"maximum":3.5000,"gross_charge":3.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"}]}]},{"description":"Guidewire Introducer Needle Remington","code_information":[ { "code": "2780820", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.5000,"maximum":3.5000,"gross_charge":3.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.5000,"methodology":"fee schedule"}]}]},{"description":"Guiding Catheter 6F XB 3.5 100cm","code_information":[ { "code": "270000535", "type": "LOCAL" } ],"standard_charges":[{"minimum":147.0000,"maximum":147.0000,"gross_charge":147.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":147.0000,"methodology":"fee schedule"}]}]},{"description":"GW N141802 NITREX V03","code_information":[ { "code": "270000685", "type": "LOCAL" } ],"standard_charges":[{"minimum":105.0000,"maximum":105.0000,"gross_charge":105.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":105.0000,"methodology":"fee schedule"}]}]},{"description":"Half Sheet Converetors","code_information":[ { "code": "270000537", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0700,"maximum":2.0700,"gross_charge":2.0700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0700,"methodology":"fee schedule"}]}]},{"description":"Harmonic 1100 Shears Integrated Hand","code_information":[ { "code": "270000539", "type": "LOCAL" } ],"standard_charges":[{"minimum":775.0800,"maximum":775.0800,"gross_charge":775.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":775.0800,"methodology":"fee schedule"}]}]},{"description":"Harmonic Blue Hand Piece and Blue Test","code_information":[ { "code": "270000541", "type": "LOCAL" } ],"standard_charges":[{"minimum":27328.0000,"maximum":27328.0000,"gross_charge":27328.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":27328.0000,"methodology":"fee schedule"}]}]},{"description":"Harmonic Focus Shears + Adaptative","code_information":[ { "code": "270001253", "type": "LOCAL" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Harmonic HD 1000i Shears Integrated","code_information":[ { "code": "270000543", "type": "LOCAL" } ],"standard_charges":[{"minimum":774.2000,"maximum":774.2000,"gross_charge":774.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":774.2000,"methodology":"fee schedule"}]}]},{"description":"Harmony Delivery Catheter System 25 Fr","code_information":[ { "code": "3020666", "type": "LOCAL" } ],"standard_charges":[{"minimum":8400.0000,"maximum":8400.0000,"gross_charge":8400.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8400.0000,"methodology":"fee schedule"}]}]},{"description":"Hema-Carotid Vascular Patch Ultrathin","code_information":[ { "code": "2700854", "type": "LOCAL" } ],"standard_charges":[{"minimum":112.0000,"maximum":112.0000,"gross_charge":112.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":112.0000,"methodology":"fee schedule"}]}]},{"description":"Hemashield Woven Double Velour","code_information":[ { "code": "2700908", "type": "LOCAL" } ],"standard_charges":[{"minimum":996.1000,"maximum":996.1000,"gross_charge":996.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":996.1000,"methodology":"fee schedule"}]}]},{"description":"Hemashield Knitted Double 2_x001D_ X 6\"","code_information":[ { "code": "2710995", "type": "LOCAL" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":868.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoclip Large","code_information":[ { "code": "2705419", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.2000,"maximum":1.2000,"gross_charge":1.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.2000,"methodology":"fee schedule"}]}]},{"description":"Hemoclip Medium","code_information":[ { "code": "270001257", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.3400,"maximum":1.3400,"gross_charge":1.3400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3400,"methodology":"fee schedule"}]}]},{"description":"Hemoclip Med-Large","code_information":[ { "code": "270001255", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.6500,"maximum":1.6500,"gross_charge":1.6500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.6500,"methodology":"fee schedule"}]}]},{"description":"Hemoclip Small","code_information":[ { "code": "270001259", "type": "LOCAL" } ],"standard_charges":[{"minimum":9.9000,"maximum":9.9000,"gross_charge":9.9000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9.9000,"methodology":"fee schedule"}]}]},{"description":"Hemoconcentrator Perfusion Service","code_information":[ { "code": "2740020", "type": "LOCAL" } ],"standard_charges":[{"minimum":126.0000,"maximum":126.0000,"gross_charge":126.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.0000,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin S, per test","code_information":[ { "code": "83021", "type": "LOCAL" } ],"standard_charges":[{"minimum":62.5000,"maximum":62.5000,"gross_charge":62.5000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":62.5000,"methodology":"fee schedule"}]}]},{"description":"Hemopad","code_information":[ { "code": "2710391", "type": "LOCAL" } ],"standard_charges":[{"minimum":29.0000,"maximum":29.0000,"gross_charge":29.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":29.0000,"methodology":"fee schedule"}]}]},{"description":"Hex Wrench Model","code_information":[ { "code": "270000545", "type": "LOCAL" } ],"standard_charges":[{"minimum":51.8000,"maximum":51.8000,"gross_charge":51.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":51.8000,"methodology":"fee schedule"}]}]},{"description":"Hi-Torque Whisper MS Guide Wire","code_information":[ { "code": "270000547", "type": "LOCAL" } ],"standard_charges":[{"minimum":126.3500,"maximum":126.3500,"gross_charge":126.3500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":126.3500,"methodology":"fee schedule"}]}]},{"description":"Humidifier","code_information":[ { "code": "270000549", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.4000,"maximum":2.4000,"gross_charge":2.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.4000,"methodology":"fee schedule"}]}]},{"description":"Humulin R Insulin Human Injection, USP","code_information":[ { "code": "250001107", "type": "LOCAL" } ],"standard_charges":[{"minimum":20.8200,"maximum":20.8200,"gross_charge":20.8200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":20.8200,"methodology":"fee schedule"}]}]},{"description":"Hydrophilic Coated Spring Coil Guide","code_information":[ { "code": "270000551", "type": "LOCAL" } ],"standard_charges":[{"minimum":187.6000,"maximum":187.6000,"gross_charge":187.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":187.6000,"methodology":"fee schedule"}]}]},{"description":"Hydrophilic Guidewire 0.035in x 180cm","code_information":[ { "code": "270000553", "type": "LOCAL" } ],"standard_charges":[{"minimum":665.0000,"maximum":665.0000,"gross_charge":665.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":665.0000,"methodology":"fee schedule"}]}]},{"description":"Hypafix","code_information":[ { "code": "2772403", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.7200,"maximum":11.7200,"gross_charge":11.7200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.7200,"methodology":"fee schedule"}]}]},{"description":"Hypoallergenic Electrodes","code_information":[ { "code": "2700181", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.2800,"maximum":0.2800,"gross_charge":0.2800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.2800,"methodology":"fee schedule"}]}]},{"description":"ICD Fortify DR","code_information":[ { "code": "2820146", "type": "LOCAL" } ],"standard_charges":[{"minimum":18998.0000,"maximum":18998.0000,"gross_charge":18998.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18998.0000,"methodology":"fee schedule"}]}]},{"description":"ICD-VR DVFC3D1 Visia AF MRI S US DF1","code_information":[ { "code": "3017510", "type": "LOCAL" } ],"standard_charges":[{"minimum":11175.0000,"maximum":11175.0000,"gross_charge":11175.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11175.0000,"methodology":"fee schedule"}]}]},{"description":"Ice Bag Adult","code_information":[ { "code": "2700810", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.4600,"maximum":4.4600,"gross_charge":4.4600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.4600,"methodology":"fee schedule"}]}]},{"description":"ICU Intermediate","code_information":[ { "code": "110000015", "type": "LOCAL" } ],"standard_charges":[{"minimum":409.2900,"maximum":1495.0000,"gross_charge":409.2900,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":409.2900,"methodology":"per diem"}]}]},{"description":"ICU Peds","code_information":[ { "code": "203000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":371.4300,"maximum":1495.0000,"gross_charge":371.4300,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":371.4300,"methodology":"per diem"}]}]},{"description":"IGA Testing","code_information":[ { "code": "NRL40", "type": "LOCAL" } ],"standard_charges":[{"minimum":350.0000,"maximum":350.0000,"gross_charge":350.0000,"setting":"both","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":350.0000,"methodology":"fee schedule"}]}]},{"description":"Infant SpO2 Sensor","code_information":[ { "code": "270000555", "type": "LOCAL" } ],"standard_charges":[{"minimum":26.2500,"maximum":26.2500,"gross_charge":26.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":26.2500,"methodology":"fee schedule"}]}]},{"description":"Infant Vent Catheter (LV Vent)","code_information":[ { "code": "2702420", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.1200,"maximum":8.1200,"gross_charge":8.1200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"}]}]},{"description":"INFINITI Angiographic Catheter (PIG)","code_information":[ { "code": "270000557", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter (PIG)","code_information":[ { "code": "270000559", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter (PIG)","code_information":[ { "code": "270000561", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"INFINITI Diagstic Catheter JR-4","code_information":[ { "code": "270000563", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Infiniti Thrulumen 5Fr.\/100cm\/.47in ID","code_information":[ { "code": "3018042", "type": "LOCAL" } ],"standard_charges":[{"minimum":16.8000,"maximum":16.8000,"gross_charge":16.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"Infiniti Thrulumen 6Fr.\/100cm\/.57in","code_information":[ { "code": "3018041", "type": "LOCAL" } ],"standard_charges":[{"minimum":16.8000,"maximum":16.8000,"gross_charge":16.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":16.8000,"methodology":"fee schedule"}]}]},{"description":"INFINITY Diagstic Catheter JR-4","code_information":[ { "code": "270000565", "type": "LOCAL" } ],"standard_charges":[{"minimum":84.0000,"maximum":84.0000,"gross_charge":84.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":84.0000,"methodology":"fee schedule"}]}]},{"description":"Ingevity + 7841 52CM","code_information":[ { "code": "3017220", "type": "LOCAL" } ],"standard_charges":[{"minimum":819.0000,"maximum":819.0000,"gross_charge":819.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":819.0000,"methodology":"fee schedule"}]}]},{"description":"Ingevity+ 7840 45CM","code_information":[ { "code": "3020156", "type": "LOCAL" } ],"standard_charges":[{"minimum":805.0000,"maximum":805.0000,"gross_charge":805.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":805.0000,"methodology":"fee schedule"}]}]},{"description":"Injection Cap","code_information":[ { "code": "2701310", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0000,"maximum":2.0000,"gross_charge":2.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"}]}]},{"description":"Inpatient Step - Down Unit (For patient in Emergency Room w admission order)","code_information":[ { "code": "160000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":371.4300,"maximum":400.0000,"gross_charge":371.4300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"}]}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021080", "type": "LOCAL" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"}]}]},{"description":"Inspire Resilia Aortic Bioprosthesis","code_information":[ { "code": "3021081", "type": "LOCAL" } ],"standard_charges":[{"minimum":6986.0000,"maximum":6986.0000,"gross_charge":6986.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6986.0000,"methodology":"fee schedule"}]}]},{"description":"Instranetics Surgical Marking Pen","code_information":[ { "code": "270000567", "type": "LOCAL" } ],"standard_charges":[{"minimum":13.0600,"maximum":13.0600,"gross_charge":13.0600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":13.0600,"methodology":"fee schedule"}]}]},{"description":"Intensive Care Surgical","code_information":[ { "code": "201000001", "type": "LOCAL" } ],"standard_charges":[{"minimum":1199.8000,"maximum":1070.0000,"gross_charge":1199.8000,"setting":"inpatient","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1002.0000,"methodology":"per diem"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1199.8000,"methodology":"per diem"}]}]},{"description":"Intensive Care Unit (ICU) Psych","code_information":[ { "code": "120000007", "type": "LOCAL" } ],"standard_charges":[{"minimum":371.4300,"maximum":1495.0000,"gross_charge":371.4300,"setting":"inpatient","payers_information":[{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":371.4300,"methodology":"per diem"}]}]},{"description":"Intergard Aortic ARCH #24mm","code_information":[ { "code": "2760101", "type": "LOCAL" } ],"standard_charges":[{"minimum":980.0000,"maximum":980.0000,"gross_charge":980.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":980.0000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711176", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711178", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2711181", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Collagen Coated","code_information":[ { "code": "2780000", "type": "LOCAL" } ],"standard_charges":[{"minimum":821.8000,"maximum":821.8000,"gross_charge":821.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":821.8000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #24MM x","code_information":[ { "code": "2711209", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #10mm X","code_information":[ { "code": "2711186", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #22mm X","code_information":[ { "code": "2711197", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Knitted Straight #8mm X 40cm","code_information":[ { "code": "2719754", "type": "LOCAL" } ],"standard_charges":[{"minimum":565.6000,"maximum":565.6000,"gross_charge":565.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":565.6000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 10 X 30cm Straight","code_information":[ { "code": "2711207", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 26 x 10cm Straight","code_information":[ { "code": "2711213", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 28 X 30cm Straight.","code_information":[ { "code": "2711216", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven 30 X 30cm Straight","code_information":[ { "code": "2711226", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2710941", "type": "LOCAL" } ],"standard_charges":[{"minimum":727.3000,"maximum":727.3000,"gross_charge":727.3000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":727.3000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2711218", "type": "LOCAL" } ],"standard_charges":[{"minimum":786.1000,"maximum":786.1000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":786.1000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2780608", "type": "LOCAL" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":868.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"Intergard Woven Collagen Coated","code_information":[ { "code": "2781619", "type": "LOCAL" } ],"standard_charges":[{"minimum":868.0000,"maximum":868.0000,"gross_charge":786.1000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":868.0000,"methodology":"fee schedule"}]}]},{"description":"INTERING VASC GRAFT STR TW IR 6mmX80cm","code_information":[ { "code": "2740135", "type": "LOCAL" } ],"standard_charges":[{"minimum":1659.0000,"maximum":1659.0000,"gross_charge":1659.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1659.0000,"methodology":"fee schedule"}]}]},{"description":"Interject (Injection Therapy Needle","code_information":[ { "code": "2810766", "type": "LOCAL" } ],"standard_charges":[{"minimum":231.0000,"maximum":231.0000,"gross_charge":231.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":231.0000,"methodology":"fee schedule"}]}]},{"description":"Intermediate Care (Telemetry)","code_information":[ { "code": "206000005", "type": "LOCAL" } ],"standard_charges":[{"minimum":480.7100,"maximum":968.0000,"gross_charge":480.7100,"setting":"inpatient","payers_information":[{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"per diem"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":480.7100,"methodology":"per diem"}]}]},{"description":"Intra-Aortic Ballon Tray Ready (IABP","code_information":[ { "code": "2704760", "type": "LOCAL" } ],"standard_charges":[{"minimum":1300.0000,"maximum":1300.0000,"gross_charge":1300.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1300.0000,"methodology":"fee schedule"}]}]},{"description":"Intra-Aortic Balloon Catheter and","code_information":[ { "code": "2721120", "type": "LOCAL" } ],"standard_charges":[{"minimum":1540.0000,"maximum":1540.0000,"gross_charge":1540.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1540.0000,"methodology":"fee schedule"}]}]},{"description":"INTRO HLS2507MCN Safe Sheath 7 FR 25CM","code_information":[ { "code": "3020167", "type": "LOCAL" } ],"standard_charges":[{"minimum":78.4000,"maximum":78.4000,"gross_charge":78.4000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":78.4000,"methodology":"fee schedule"}]}]},{"description":"Introducer SS 808800 8F W\/VALSIDEPOR","code_information":[ { "code": "2797173", "type": "LOCAL" } ],"standard_charges":[{"minimum":18.2000,"maximum":18.2000,"gross_charge":18.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":18.2000,"methodology":"fee schedule"}]}]},{"description":"Intubating Style Adult","code_information":[ { "code": "2709185", "type": "LOCAL" } ],"standard_charges":[{"minimum":35.0000,"maximum":35.0000,"gross_charge":35.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":35.0000,"methodology":"fee schedule"}]}]},{"description":"Ioban 3M","code_information":[ { "code": "270000569", "type": "LOCAL" } ],"standard_charges":[{"minimum":11.8400,"maximum":11.8400,"gross_charge":11.8400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":11.8400,"methodology":"fee schedule"}]}]},{"description":"Irrigation Tray","code_information":[ { "code": "2709600", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1900,"maximum":1.1900,"gross_charge":1.1900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"}]}]},{"description":"Irrigation Tray With Bulb Syringe","code_information":[ { "code": "270000571", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0500,"maximum":2.0500,"gross_charge":2.0500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0500,"methodology":"fee schedule"}]}]},{"description":"IS-1 (3.2mm) Receptacle Plug","code_information":[ { "code": "270000573", "type": "LOCAL" } ],"standard_charges":[{"minimum":119.0000,"maximum":119.0000,"gross_charge":119.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":119.0000,"methodology":"fee schedule"}]}]},{"description":"IS4\/DF4 Connector Sleeve","code_information":[ { "code": "270000575", "type": "LOCAL" } ],"standard_charges":[{"minimum":9139.2000,"maximum":9139.2000,"gross_charge":9139.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":9139.2000,"methodology":"fee schedule"}]}]},{"description":"IS4\/DF4 Plug","code_information":[ { "code": "2730053", "type": "LOCAL" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"ISOFLEX Pacing lead","code_information":[ { "code": "2820699", "type": "LOCAL" } ],"standard_charges":[{"minimum":770.0000,"maximum":770.0000,"gross_charge":770.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":770.0000,"methodology":"fee schedule"}]}]},{"description":"Isolation","code_information":[ { "code": "164000005", "type": "LOCAL" } ],"standard_charges":[{"minimum":410.0000,"maximum":410.0000,"gross_charge":410.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Advantage","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":410.0000,"methodology":"per diem"}]}]},{"description":"IV Normal Saline In Plastic","code_information":[ { "code": "250000005", "type": "LOCAL" } ],"standard_charges":[{"minimum":8.1200,"maximum":8.1200,"gross_charge":8.1200,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":8.1200,"methodology":"fee schedule"}]}]},{"description":"IV Start Kit (Pack Chlorapred)","code_information":[ { "code": "270000577", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.3700,"maximum":1.3700,"gross_charge":1.3700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.3700,"methodology":"fee schedule"}]}]},{"description":"IV Transparent Dressing 3.5 x 4.5 in.","code_information":[ { "code": "2780901", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.5000,"maximum":0.5000,"gross_charge":0.5000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5000,"methodology":"fee schedule"}]}]},{"description":"Jackson-Pratt Reservoirs 100ML","code_information":[ { "code": "270000579", "type": "LOCAL" } ],"standard_charges":[{"minimum":21.0300,"maximum":21.0300,"gross_charge":21.0300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0300,"methodology":"fee schedule"}]}]},{"description":"Jot Dx Insertable Cardiac Monitor","code_information":[ { "code": "2750479", "type": "LOCAL" } ],"standard_charges":[{"minimum":3500.0000,"maximum":3500.0000,"gross_charge":3500.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3500.0000,"methodology":"fee schedule"}]}]},{"description":"J-Vac Suction Reservoir","code_information":[ { "code": "270001261", "type": "LOCAL" } ],"standard_charges":[{"minimum":21.0400,"maximum":21.0400,"gross_charge":21.0400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":21.0400,"methodology":"fee schedule"}]}]},{"description":"Ketamine HCl Injection, USP 50 mg\/mL","code_information":[ { "code": "250001159", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.9000,"maximum":0.9000,"gross_charge":0.9000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.9000,"methodology":"fee schedule"}]}]},{"description":"Kittner Rolls Gauze Large X-Ray","code_information":[ { "code": "2708375", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0000,"maximum":2.0000,"gross_charge":2.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0000,"methodology":"fee schedule"}]}]},{"description":"Konect Resilia Aortic Valved Conduit","code_information":[ { "code": "3020098", "type": "LOCAL" } ],"standard_charges":[{"minimum":15540.0000,"maximum":15540.0000,"gross_charge":15540.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":15540.0000,"methodology":"fee schedule"}]}]},{"description":"Krinkle Gauze Roll (kerlix) 4.5 X 4.1","code_information":[ { "code": "270000581", "type": "LOCAL" } ],"standard_charges":[{"minimum":1.1900,"maximum":1.1900,"gross_charge":1.1900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1.1900,"methodology":"fee schedule"}]}]},{"description":"Krinkle Gauze Roll 4.5\"x 4.1 (Kerlex","code_information":[ { "code": "270000583", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.0400,"maximum":0.0400,"gross_charge":0.0400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.0400,"methodology":"fee schedule"}]}]},{"description":"Lab Sponge 18 x 18 in.","code_information":[ { "code": "270000585", "type": "LOCAL" } ],"standard_charges":[{"minimum":0.5500,"maximum":0.5500,"gross_charge":0.5500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee 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separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":0.5500,"methodology":"fee schedule"}]}]},{"description":"Lactated Ringer's Injection USP 500ML","code_information":[ { "code": "270000587", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.2900,"maximum":2.2900,"gross_charge":2.2900,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":2.2900,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical 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],"standard_charges":[{"minimum":2058.0000,"maximum":2058.0000,"gross_charge":2058.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":2058.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM 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Vital","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","standard_charge_dollar":37.1000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","standard_charge_dollar":37.1000,"methodology":"fee schedule"}]}]},{"description":"Laringeal Mask 1.5","code_information":[ { "code": "3009197", "type": "LOCAL" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":39.2000,"methodology":"fee 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"270001055", "type": "LOCAL" } ],"standard_charges":[{"minimum":25.6700,"maximum":25.6700,"gross_charge":25.6700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","standard_charge_dollar":25.6700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","standard_charge_dollar":25.6700,"methodology":"fee 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separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":7014.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM 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],"standard_charges":[{"minimum":500.0000,"maximum":500.0000,"gross_charge":500.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":500.0000,"methodology":"fee 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separately","standard_charge_dollar":500.0000,"methodology":"fee schedule"}]}]},{"description":"Vaseline Petrolatum Gauze Strip 3'' x","code_information":[ { "code": "270001057", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7600,"maximum":3.7600,"gross_charge":3.7600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7600,"methodology":"fee 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schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":91.0000,"methodology":"fee schedule"}]}]},{"description":"Vegram Balloon Catheter","code_information":[ { "code": "270001061", "type": "LOCAL" } ],"standard_charges":[{"minimum":140.0000,"maximum":140.0000,"gross_charge":140.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":140.0000,"methodology":"fee schedule"}]}]},{"description":"Vein Pick (Model 6541)","code_information":[ { "code": "270001059", "type": "LOCAL" } ],"standard_charges":[{"minimum":42.0000,"maximum":42.0000,"gross_charge":42.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":42.0000,"methodology":"fee schedule"}]}]},{"description":"VenaSeal Closure System","code_information":[ { "code": "270001345", "type": "LOCAL" } ],"standard_charges":[{"minimum":1680.0000,"maximum":1680.0000,"gross_charge":1680.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1680.0000,"methodology":"fee schedule"}]}]},{"description":"Ventury Mask","code_information":[ { "code": "270001063", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.3100,"maximum":3.3100,"gross_charge":3.3100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3100,"methodology":"fee schedule"}]}]},{"description":"VersaCross Connect LAAC Access","code_information":[ { "code": "3021220", "type": "LOCAL" } ],"standard_charges":[{"minimum":1253.0000,"maximum":1253.0000,"gross_charge":1253.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":1253.0000,"methodology":"fee schedule"}]}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021166", "type": "LOCAL" } ],"standard_charges":[{"minimum":560.0000,"maximum":560.0000,"gross_charge":560.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":560.0000,"methodology":"fee schedule"}]}]},{"description":"VersaOne Optical Trocar with Fixation","code_information":[ { "code": "3021167", "type": "LOCAL" } ],"standard_charges":[{"minimum":546.0000,"maximum":546.0000,"gross_charge":546.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":546.0000,"methodology":"fee schedule"}]}]},{"description":"Vesseal Sealer Extend","code_information":[ { "code": "3021112", "type": "LOCAL" } ],"standard_charges":[{"minimum":918.8700,"maximum":918.8700,"gross_charge":918.8700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":918.8700,"methodology":"fee schedule"}]}]},{"description":"Vessel Cannula","code_information":[ { "code": "2705456", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.1300,"maximum":6.1300,"gross_charge":6.1300,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.1300,"methodology":"fee schedule"}]}]},{"description":"Veus Cannula 32\/40 Fr","code_information":[ { "code": "2702630", "type": "LOCAL" } ],"standard_charges":[{"minimum":56.0000,"maximum":56.0000,"gross_charge":56.0000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":56.0000,"methodology":"fee schedule"}]}]},{"description":"Veus Cannula Pediatric","code_information":[ { "code": "2702625", "type": "LOCAL" } ],"standard_charges":[{"minimum":39.2000,"maximum":39.2000,"gross_charge":39.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":39.2000,"methodology":"fee schedule"}]}]},{"description":"VIABAHN BX BALLOON EXP ENDO 8mmX59mm","code_information":[ { "code": "3021051", "type": "LOCAL" } ],"standard_charges":[{"minimum":5653.2000,"maximum":5653.2000,"gross_charge":5653.2000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5653.2000,"methodology":"fee schedule"}]}]},{"description":"VIABAHN SX ENDO 35 RO 5mmX5cm 7Fr","code_information":[ { "code": "3020841", "type": "LOCAL" } ],"standard_charges":[{"minimum":3544.8000,"maximum":3544.8000,"gross_charge":3544.8000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3544.8000,"methodology":"fee schedule"}]}]},{"description":"Viaflex 1000ml (empty)","code_information":[ { "code": "2707995", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.2500,"maximum":5.2500,"gross_charge":5.2500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.2500,"methodology":"fee schedule"}]}]},{"description":"Vicryl 1 36\"","code_information":[ { "code": "270001065", "type": "LOCAL" } ],"standard_charges":[{"minimum":6.3600,"maximum":6.3600,"gross_charge":6.3600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":6.3600,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2 TP-1 (4 X 27\")","code_information":[ { "code": "270001067", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0500,"maximum":3.0500,"gross_charge":3.0500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"}]}]},{"description":"VICRYL 2-0 36\" CTX","code_information":[ { "code": "270001069", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7700,"maximum":3.7700,"gross_charge":3.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2-0 54\" LIGAPAK","code_information":[ { "code": "270001071", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0500,"maximum":3.0500,"gross_charge":3.0500,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0500,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2-0 CT-1 36\"","code_information":[ { "code": "270001073", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7700,"maximum":3.7700,"gross_charge":3.7700,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7700,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2-0 SH 27\"","code_information":[ { "code": "270001075", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.6000,"maximum":5.6000,"gross_charge":5.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2-0 VCP 204G","code_information":[ { "code": "2760092", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.0800,"maximum":3.0800,"gross_charge":3.0800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.0800,"methodology":"fee schedule"}]}]},{"description":"Vicryl 2-0 VCP 523H","code_information":[ { "code": "2700311", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.3600,"maximum":3.3600,"gross_charge":3.3600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.3600,"methodology":"fee schedule"}]}]},{"description":"Vicryl 3-0 (54'') Ligapak J205G","code_information":[ { "code": "270001077", "type": "LOCAL" } ],"standard_charges":[{"minimum":5.6000,"maximum":5.6000,"gross_charge":5.6000,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":5.6000,"methodology":"fee schedule"}]}]},{"description":"Vicryl 3-0 27 Ps-1","code_information":[ { "code": "270001079", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.1100,"maximum":3.1100,"gross_charge":3.1100,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1100,"methodology":"fee schedule"}]}]},{"description":"Vicryl 3-0 Sh 27\"","code_information":[ { "code": "270001081", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7400,"maximum":3.7400,"gross_charge":3.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"}]}]},{"description":"Vicryl 3-0 VCP458","code_information":[ { "code": "2710312", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.1800,"maximum":3.1800,"gross_charge":3.1800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.1800,"methodology":"fee schedule"}]}]},{"description":"Vicryl 4-0 (54'') Ligapak J204G","code_information":[ { "code": "270001083", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.3800,"maximum":4.3800,"gross_charge":4.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"}]}]},{"description":"Vicryl 4-0 27\" Ps-2","code_information":[ { "code": "270001085", "type": "LOCAL" } ],"standard_charges":[{"minimum":4.3800,"maximum":4.3800,"gross_charge":4.3800,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":4.3800,"methodology":"fee schedule"}]}]},{"description":"Vicryl 4-0 VCP662H","code_information":[ { "code": "2730414", "type": "LOCAL" } ],"standard_charges":[{"minimum":2.0600,"maximum":2.0600,"gross_charge":2.0600,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Mapfre","plan_name":"Mapfre","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"MCS","plan_name":"MCS Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Menonita","plan_name":"Menonita Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"MMM","plan_name":"MMM Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Prossam","plan_name":"Prossam","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Comercial","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"},{"payer_name":"Triple S","plan_name":"Triple S Vital","additional_payer_notes":"Could be billed separately","standard_charge_dollar":2.0600,"methodology":"fee schedule"}]}]},{"description":"Vicryl Plus CT-1 1 \/ 27\"","code_information":[ { "code": "270001087", "type": "LOCAL" } ],"standard_charges":[{"minimum":3.7400,"maximum":3.7400,"gross_charge":3.7400,"setting":"inpatient","payers_information":[{"payer_name":"ACAA","plan_name":"ACAA","additional_payer_notes":"Could be billed separately","standard_charge_dollar":3.7400,"methodology":"fee schedule"},{"payer_name":"First Medical","plan_name":"First Medical 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